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Medicaid Works for Vulnerable Communities

February 2, 2018 at 11:15 AM

The Trump Administration has started letting states make counterproductive work requirements a condition of Medicaid eligibility, and it’s expected to approve Indiana’s request today to impose such requirements in its Medicaid program.  These Medicaid changes and others that policymakers have recently considered would undermine the program’s ability to provide tens of millions of Americans — particularly children, seniors, people with substance use disorders (SUDs), and people in rural communities — with critical access to comprehensive, cost-effective care, as we show in a new set of fact sheets.

Medicaid produces long-term improvements in health and well-being for a wide range of people, research shows.  And with states expanding Medicaid eligibility under the Affordable Care Act, more people have benefitted.  After Arkansas and Kentucky expanded access, for example, the shares of people with a personal doctor, people who received a checkup in the last year, and people who said they were in excellent health all rose compared to Texas, which didn’t expand.  Long-term Medicaid eligibility is associated with reduced mortality rates and increases in college attendance and completion.

Our new briefs show the importance of Medicaid for four groups especially:

  • For children: Medicaid covers nearly half of all U.S. births, and expansions in Medicaid coverage  reduced rates of infant mortality and incidence of low birth weight.
  • For seniors: Medicaid is the primary payer for essential long-term services and supports, which aren’t covered through Medicare and are far too costly for most seniors and their families to fund out of pocket.
  • For people with SUDs: Medicaid is the nation’s largest payer for behavioral health services, including evidence-based treatment services and mental health services that are critical for people with SUDs who also have co-occurring mental health needs.
  • For people in rural communities: Medicaid protects access to care by helping sustain rural hospitals and other providers.  Medicaid expansion helped reduce uncompensated care costs by about half between 2013 and 2015, improving rural hospital finances.

Work requirements, on the other hand, will threaten health coverage for thousands of adults, many of whom would actually find it harder to succeed in the labor market due to their loss of coverage.  And millions more Medicaid enrollees would lose coverage, and hundreds of billions of dollars in federal Medicaid funding would be cut, under congressional proposals to roll back Medicaid expansions and impose a cap on federal Medicaid funding that would fail to keep pace with growing coverage needs.

Instead of undermining access to Medicaid coverage, the Administration should support positive state innovations that improve coverage for vulnerable communities and all Americans.


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