Prior to COVID-19, there was a large-scale movement to impose additional requirements on Medicaid beneficiaries. Specifically, in 2018 the Centers for Medicare & Medicaid Services (CMS) solicited proposals, and began approving, so-called "Work for Medicaid" programs.
Contrary to the title, Work for Medicaid does not require beneficiaries to have a job to qualify for benefits; the beneficiaries can also qualify by participating in community engagement activities such as education, vocational training, caregiving, or volunteering.
There are also exemptions for various categories of beneficiaries who may not be able to participate in these activities, e.g., pregnant women or "medically frail individuals." The idea was to encourage program participants to become self-sufficient and escape poverty.
Challenges to these programs ensued, even going as high as the Supreme Court, despite the fact that the bases of the programs were not novel. Work requirements for the receipt of benefits have been part of similar programs for years.
For example, the Supplemental Nutrition Assistance Program (SNAP) has work requirements and exemption categories that are similar to the Work for Medicaid Pilot programs.
Assuming the programs would be viable, legal practitioners began to prepare for what seemed to be an all-but-certain wave of enforcement activity targeting fraudulent activity in order to meet the new Medicaid requirements. But it never came.