The White House’s new budget envisions cutting hundreds of thousands of people from Medicaid’s rolls by asking them to get a job.
President Trump is eyeing similar pushes for those on food stamps and those receiving federal housing assistance, saying asking able-bodied people to try to find work is good not only for taxpayers but also as a way to lift people out of poverty.
Medicaid alone stands to save $130 billion over the next decade if Congress enacts Mr. Trump’s work proposal, the White House predicts in its fiscal 2020 budget.
“We can help low-income families and end dependency on government benefits by strengthening work requirements,” said Russell Vought, acting director of the Office of Management and Budget.
The administration has toyed with work proposals before, including offering states the chance to write their own work requirements into their Medicaid programs. Monday’s plan goes further, calling for a national policy.
Budget writers will fill in details in the coming days, though the new rules generally would apply to those ages 18 to 64. The rules would include “hardship” exemptions for those who are unable to comply.
The Center on Budget and Policy Priorities said, based on the $130 billion savings, the administration would have to cut at least 1.7 million people from its rolls each year, beginning in 2021.
Republicans generally support work requirements, saying they improve standards of living by enticing people off the government dole.
The move also has a natural appeal to the public.
“Just as a general matter, most Americans support the idea of expecting people receiving government assistance to do what they can to support themselves,” said Matt Weidinger, a resident fellow at the American Enterprise Institute who worked for Republicans on the House Ways and Means Committee for decades. “There’s no time like the present to do that.”
Yet Mr. Trump’s across-the-board approach to work requirements will not be greeted warmly by House Democrats who have staunchly opposed his decision to let states impose work requirements on Medicaid, the federal-state insurance program for the poor.
“We will certainly fight against any proposed cuts that target Americans’ basic standard of living,” said Alexandra Weinroth, spokeswoman for House Budget Committee Chairman John Yarmuth, Kentucky Democrat.
In addition to Medicaid, the budget outline released Monday says those receiving rental assistance from the Department of Housing and Urban Development would have to work or receive job training for at least 20 hours per week.
It also says states must use 30 percent of their funding for Temporary Assistance for Needy Families (TANF) — a welfare program that already requires participants to seek work — on education and job training.
Stacy Dean, vice president for food assistance policy at the Center on Budget and Policy Priorities, said childless adults age 18 to 49 who receive Supplemental Nutrition Assistance Program (SNAP) benefits, or food stamps, already must work 20 hours per week, though the latest proposal appears to extend the requirement to adults up to age 64.
“So basically what you’re talking about is raising the age and including parents,” she said.
Mr. Trump’s earlier experiment — allowing states to ask for federal waivers to test work requirements on their own Medicaid populations — got mixed results.
Eight states have taken up the administration on its offer, and they have been met with litigation from critics who say the requirements can be confusing, stretch the law and go beyond the main intent of the Great Society program — to insure people.
Roughly 18,000 Arkansans have been booted off the rolls since the new rules took effect in that state.
The Medicaid and CHIP Payment and Access Commission — an advisory group known as MACPAC — urged the administration last year to stop letting states remove people from the rolls until steps are taken to promote awareness of the rules and improve compliance.
“In spite of all that criticism, they’re just continuing on that path,” said Aviva Aron-Dine, vice president for health policy at the Center on Budget and Policy Priorities.
At the White House, Mr. Vought said the administration would try to ease the transition to work requirements. He said the Labor Department has enough money to fund help people who would be subject to the requirements and need help in landing a job.
“There will be many, many workforce development programs that are funded as part of this budget,” he said.
• A previous version of this story misidentified the organization where Matt Weidinger — a resident fellow in poverty studies — works. He is employed by the American Enterprise Institute.