Suggested keywords: welfare reform, TANF, work requirements, Medicaid, SNAP, welfare fraud, Trump administration.
Three decades after Clinton-era welfare reform, the second Trump administration has initiated its own changes to the system which strengthen work requirements for Medicaid and other benefits. Anne Daguerre looks at the history of US welfare programmes since the late 1990s, writing that while the earlier reforms, despite often being a means for fraud by state officials, claimed to be about helping the poor, the latest changes are more focused on reducing federal spending.
Saturday 22 August 2026 marked the 30th anniversary of welfare reform, signed into law by President Bill Clinton. The legislation terminated cash assistance as an entitlement for poor single-parent families. States are required to have 50 percent of all families and 90 percent of two-parent families engaged in work but can meet the work standard by reducing the number of families receiving assistance. The result: the caseload decreased from 4.4 million families in 1996 to one million today, a reduction of 77 percent over three decades. Gone, too, is the welfare cheque: according to the Government Accountability Office, more than 75 per cent of Temporary Assistance for Needy Families (TANF) funds went directly to families as cash in the late 1990s; today, states spend the bulk on programmes and organisations providing education and training, child care and parenting services.
Welfare assistance since the 1990s: success or slush fund?
Despite notions that welfare fraud by recipients is widespread, fraud is more likely to take place where the money is: at the state and organisational level, when an organisation overcharges for services or bills the state for services never provided. Mississippi has been a case in point.
As Anna Wolfe, the Mississippi Today reporter who uncovered fraud at the hands of state officials, has shown, TANF worked as a state slush fund. Starting in the 2010s, the Mississippi Department of Human Services rejected almost 99 per cent of applicants for TANF. It had spare cash to spend, which the head of the state welfare agency, John Davis, did, but not on families. Instead, funds were redirected to organizations with fake contracts that did not provide any services. In 2022, Davis pleaded guilty to defrauding the state of Mississippi of millions of dollars. This was a sophisticated welfare fraud scheme, involving the rich and powerful stealing from the poor, in a state where TANF reaches two of every 100 families in poverty.
And yet, the programme is portrayed as a success. Here is what Donald Trump wrote in 2011, in Time to Get Tough: “The secret to the 1996 Welfare Reform success was that it tied welfare to work. To get your check, you had to prove that you were enrolled in job-training or trying to find work.”
For conservative think tanks such as the Heritage Foundation and the American Enterprise Institute, TANF has been a success story, worth defending against “revisionist” narratives. In truth, Democrats have lost interest in a programme that is now virtually extinct. They have preferred to expand other means-tested programmes: Food Stamps, renamed the Supplemental Nutrition Assistance Program (SNAP), which reached a peak of over 47 million recipients in 2013 and still served 42 million in 2025. Medicaid, together with the Children’s Health Insurance Program (CHIP) covers almost 74 million Americans in 2026. As a result, child poverty rates following receiving assistance have remained stable: there has been no poverty explosion.
Trump has gotten tough on welfare
But this status quo, however unsatisfactory, has unravelled again. The second Trump administration has unleashed a second wave of welfare reform, which consists of cuts to all means-tested programmes under the guise of strengthening work efforts and combatting welfare fraud. Trump again, in Time to Get Tough: “But here’s the rub: the Welfare Reform Act dealt only with one program, Aid to Families with Dependent Children, not the other seventy-six welfare programs which today cost taxpayers more than $900 billion annually. We need to take a page from the 1996 reform and do the same for other welfare programs.”
So, Trump was following the Heritage Foundation blueprint when, in his first term, he signed executive orders strengthening work requirements for SNAP recipients, reversing the maximum-accessibility, no-fuss policies implemented under his predecessor, Barack Obama. But work requirements for Medicaid were absent from the conservative agenda.
This changed in the mid-2010s, when the Medicaid expansion under the Affordable Care Act allowed states to provide coverage for working-age adults with annual incomes below 138 per cent of the poverty line. Republicans protested the expansion of Medicaid to the “non-deserving” poor. But it was the Foundation for Government Accountability (FGA), that first came up with work requirement ideas for Medicaid recipients. The FGA praised the experiments “driving the nation into a new welfare reform frontier“. In 2017, the Trump administration encouraged states to experiment with community engagement programmes for newly eligible populations, with disappointing results: 18,000 people lost coverage in Arkansas in 2018–2019, without any increase in employment. In 2021 the Biden administration rescinded these work requirements.
Work requirements are back
Fast-forward to 2025: work requirements for able-bodied Medicaid recipients have become a standard recommendation across conservative think tanks. In May 2025, four Trump officials — Robert F. Kennedy Jr., Mehmet Oz, Brooke Rollins and Scott Turner penned an op-ed in the New York Times justifying work requirements, old and new, for able-bodied recipients of SNAP, Medicaid and housing assistance.
Meanwhile, the stigmatisation of benefit recipients — depicted as fraudsters and idle — has returned in force. The “welfare queen” of the 1980s, loosely based on the story of Linda Taylor, a serial scammer and criminal in 1970s Chicago, has been replaced by a new figure: a 29-year-old male playing video games on the couch.
Work requirements for most working age adult benefit recipients are now back in full swing with the One Big Beautiful Bill Act (OBBBA), signed into law in July 2025 by President Trump. Its supporters argue that millions of ‘able-bodied individuals’ will get to work as a result, completing welfare reform’s unfinished success story.
Nothing could be further from the truth. In 1996, welfare reform was not entirely about benefit cuts: it was also about getting single mothers into the fast-expanding service economy of the 1990s.
Welfare reform is about cutting spending
In 2026, there is no such pretence: adults aged 19–64 must log a minimum of 80 hours a month of work-related activity or lose eligibility for Medicaid, without any support. How these requirements will get the non-working Medicaid recipients “off the couch” is unclear—particularly when the administration’s FY2026 budget proposes cuts to Department of Labor workforce programmes, including the elimination of Job Corps.
While welfare reform restricted federal means benefits to many legal immigrants during their first five years of residency, the Beautiful Bill goes further by making access to health, nutrition, housing, childcare and other services more difficult for many immigrant and mixed-status families.
The real point of the OBBBA is not to get people into work: it is to cut federal spending to pay for tax cuts that benefit billionaires and millionaires alike. Where work enters the picture, it is solely on the business side of the equation. Four days after the law was signed, with farm labour shortages worsened by mass deportations, USDA Secretary Brooke Rollins pointed to the “34 million able-bodied adults in our Medicaid program” as potential replacements for deported farm workers. In 1996, welfare reform at least claimed to be about helping the poor. In 2026, the Trump administration makes no bones about starving people into work.
Bio: Anne Daguerre is Reader in Social Justice at the University of Brighton. She has researched welfare reform, conditionality and labour market policy in the US, UK and Europe for twenty-five years, and is the author of three monographs including Obama’s Welfare Legacy (Policy Press, 2017).
The original source for this blog is the LSE United States Politics and Policy blog