States can request county-by-county exemptions. The counties getting exemptions are 90% or more white.
“Republicans in many states are now seeking to pare back Medicaid eligibility through work requirements that they hope will discourage enrollment. They’ve largely been given a green light by the Trump administration via waivers. But a new wrinkle in the way these requirements are drawn up is driving … suspicion that the idea is to make urban minority folk work while exempting rural white beneficiaries. …
“The waiver in Kentucky, the first state to win federal approval for a Medicaid work requirement, will have the effect of exempting eight southeastern counties where the percentage of white residents is over 90 percent. The work requirements will be imposed first in … the county with the highest concentration of black residents in the state.”
“In a pending waiver request from Ohio, and in a bill passed by the GOP-controlled legislature in Michigan, counties with high unemployment rates are exempted from the work requirements entirely. These tend to be heavily white rural areas. Meanwhile, … low unemployment [rates] in relatively wealthy suburbs keep the inner cities from qualifying for the exemption. …
“Ohio’s former Medicaid director … studied the 26 counties that qualify for an exemption from the proposed Medicaid work requirements and found they are, on average, 94 percent white. Meanwhile, … ‘most of these non-exempted Ohio communities have either majority or significant African-American populations.’ The same is true in Michigan, where the discriminatory impact of the proposed work requirement has gotten significant national attention ….”
Quoted from New York magazine; read story here.