The Affordable Care Act, also known as Obamacare, expands the Medicaid entitlement to any able-bodied adult 18 to 64 years of age who earns less than 138 percent of the federal poverty level. In 2012, the U.S. Supreme Court ruled that individual states could decide whether to expand Medicaid. As of last month, 37 states, including Washington, have expanded Medicaid. (here)

The ACA has a section that encourages states to seek waivers from the federal government to individualize their Medicaid programs. Several states have sought waivers to add a work requirement for Medicaid recipients. “Work” can be defined as a typical job, community service, or educational advancements. Obviously, people with disabilities or those unable to work are not required to participate.

It is well accepted that holding down a job and education lead to better health outcomes, even though the political left has resisted the requirement. Jobs and education also improve a person’s self reliance, which should be the goal of any entitlement.

As of last month, 16 states have applied for work requirements. (here) Courts have ruled against the work requirement for three of these states.

Indiana has not only had success in implementing the state’s Medicaid work requirement, but has also had support from both the political left and right. (here) The state’s success is due to several things. First, the phase-in is gradual, taking place over six to twelve months. Participants can also move in and out of the program without being forced out of Medicaid.

Second, state officials are realistic about the number of people who are able to participate. There are more than a dozen exemptions. To date, only five percent of the expanded Medicaid population has qualified, although this number is expected to gradually grow.

Rather than using the heavy-hand of government, Indiana has taken a compassionate route to implementing its work requirement. The goal is the same, but by being realistic, the state is demonstrating a much better path to succeeding with the program. Indiana’s work requirement program should be the model for all states that have chosen to expand Medicaid.