Medicaid Work Requirements Don’t Work

Over the past few years, United States policymakers, especially Republican officials, have encouraged states to adopt work requirements for Medicaid that exclude coverage for individuals not meeting employment or community engagement criteria. Although the intent of these requirements was to promote overall employment and improved health for beneficiaries, a large fraction of individuals in states subject to these policy changes are losing coverage, including those that meet the requirements or those that should have been exempt. Ultimately, this loss of coverage creates further barriers and contradicts one of the main goals of Medicaid—to provide affordable health coverage to people who would otherwise not have it. 

A recent article explores the significance and impact of implementing Medicaid work requirements on insurance coverage and employment in the state of Arkansas. Ultimately, the study found that Medicaid work requirements lead to losses in health insurance coverage without significant increases in employment. In fact, the overall percentage of uninsured individuals increased as employment decreased. The most intriguing finding pertains to the confusion and lack of awareness that individuals have regarding changes in policy. Out of all the respondents in the study, many had not heard about the policy changes, nearly half were unsure if the policies even applied to them, and many thought that they were not meeting the requirements despite the fact that they already were. To further complicate the issue, unenrolled individuals were forced to wait another year before reapplying for health coverage. Therefore, disenrollment or suspension of coverage could increase health risks on individuals. 

The take-away message from this study, as well as several others that show increased uninsured rates without increased employment, is that Medicaid work requirements have considerably worsened and increased administrative hurdles in order for individuals to maintain coverage. The work requirements will have further consequences if implemented nationwide, as well, as they will disenroll millions of Medicaid enrollees that already meet the requirements or exemptions. As improper dissemination of information and increased paperwork burdens impact rates of coverage, automatic verification processes should be considered to keep eligible individuals covered by Medicaid. Furthermore, improved monitoring processes or evaluation periods before disenrollment could help keep many individuals eligible with much needed health insurance.

This Health Policy Journal Club review is written by Parker Mitchell as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where he is a medical student.

No abstract available.

Sommers BD, et al. N Engl J Med. 2019; 381 (11): 1073-1082.