One significant impact the Trump administration has had on Medicaid is the encouragement of states to implement work requirements for enrollees. Medicaid is the government-funded health insurance program that provides free or low-cost health coverage for eligible low-income adults. It also provides free or low-cost coverage for some children, pregnant women, seniors, and people with disabilities. Medicaid is administered jointly by state governments and the federal government—specifically, the Centers for Medicare and Medicaid Services (CMS).
Work requirements for Medicaid typically take the form of waivers. These waivers require Medicaid beneficiaries to verify that for a given number of hours a week they are either employed, actively job hunting, or enrolled in a job training program. If otherwise qualified Medicaid applicants can prove this, they can then enroll or or retain their coverage
But many experts believe that these work requirements are redundant at best and detrimental to the Medicaid program at worst, keeping people who are already actively employed from receiving benefits for which they already qualify.
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What states have Medicaid work requirements?
Right now, there are six states that have approved work requirement waivers for their Medicaid programs:
- Arizona (approved, but not implemented)
- Indiana (approved and implemented)
- Ohio (approved, but not implemented)
- South Carolina (approved, but not implemented)
- Utah (approved and implemented, but currently on hold due to COVID-19)
- Wisconsin (approved, but not implemented)
If you have Medicaid and live in one of these states, check with your state Medicaid office to make sure you’ve completed all required documentation.
There are an additional ten states with pending work requirement waivers for their Medicaid programs:
- Alabama
- Georgia
- Idaho
- Mississippi
- Montana
- Nebraska
- Oklahoma
- South Dakota
- Tennessee
- Virginia
And four states have had their work requirement waivers set aside by the federal court system:
- Arkansas
- Kentucky
- Michigan
- New Hampshire
What do we know about workforce participation of Medicaid recipients?
According to the Kaiser Family Foundation,
- 63% of non-dual, non-SSI, non-elderly adults with Medicaid already work full- or part-time
- 12% reported not working due to caregiving responsibilities at home
- 11% reported not working due to disability or illness
- 7% reported not working due to school attendance
- 7% reported not working due to retirement, inability to find work, or another reason.
In other words, the overwhelming majority of Medicaid recipients are already working or in school A small percentage are not working because of their role as caregivers in their family or an inability to work because of disability. And an even smaller percent — the most small percentage of all Medicaid recipients — are simply not working, for a number of reasons.
Health and education are key factors in determining Medicaid recipients’ ability to work. 69% of recipients who report their health as being excellent or good are currently working. Same goes for 64% who report their health as being good. Likewise, 72% of those with a Bachelor’s degree or higher are working. Over 60% of those with some college or a high school diploma are working, and over half of those with some high school are working.
How would work requirements impact Medicaid recipients?
It is predicted that between 1.5 to 4.1 million people could lose their Medicaid coverage if work requirements were implemented nationwide.
While the majority of Medicaid recipients already work full-time (35 hours a week or more) for the entire year (at least 50 weeks), many Medicaid adults do not use the computer, the internet, or email. This could be a major barrier for reporting work, even among those already working. Considering that there are high rates of functional disability and serious medical conditions among adults on Medicaid, especially among those not working, losing Medicaid coverage because of the inability to access a computer or internet could be devastating.
And considering that the implementation of work requirements in state Medicaid programs is not shown to increase employment rates or the availability of employer-based health coverage, loss of coverage because of work requirements could actually result in an increased inability to work — and increased uncompensated healthcare by providers.