BEYOND THE NUMBERS
State policies taking Medicaid coverage away from people who don’t meet a work requirement represent “policy making gone astray, causing more harm than good,” two physicians write in a commentary accompanying two new studies in the September issue of JAMA Internal Medicine. The studies come shortly after Arkansas terminated coverage for over 4,300 beneficiaries on September 1, the first Medicaid beneficiaries in any state to lose coverage because they couldn’t comply with complex work requirements.
Consistent with prior estimates, the first new study finds that most of those losing coverage due to these policies likely will be working or eligible for an exemption but unable to meet burdensome state reporting requirements. If every beneficiary eligible for an exemption got one, the savings to Medicaid from the new policies would be “minimal,” the authors conclude. And, if eliminating coverage for people who should remain eligible “is the primary mechanism by which work requirements decrease Medicaid enrollment and spending, these savings would likely come at substantial cost in terms of human health.”
The second study finds that “almost all Medicaid-eligible individuals may already meet proposed work requirements or exemptions prior to implementation. . . . In light of these findings, policymakers should consider whether administrative costs and beneficiary burdens imposed by work requirements are justified by their narrow projected reach.”
Supporters of work requirements generally say that they target only people who aren’t working, aren’t seeking work, and are able to work. While Arkansas exempts many people who the state knows are working or exempt (due to disability or for other reasons), many others must report their work hours or prove they are exempt. Other states, like Kentucky, are proposing to implement policies that don’t rely on existing data as much as Arkansas, so a far greater share of beneficiaries would have to report their activities or prove they are exempt — which means even more people would lose coverage than in Arkansas.
The new commentary takes a broad look at work requirements, noting, “Unfortunately, Medicaid work requirements are out of step with the lived experiences of low-income people, particularly the realities of the labor market they encounter. Racial discrimination, lack of reliable transportation, unstable housing, and a criminal justice history are all roadblocks to Medicaid enrollees finding work.”
The new articles add to a growing body of research showing the harm of Medicaid work requirements. A far better approach for states that want to help low-income adults find work would be to implement a robust workforce promotion program, which would provide job training and other services to the small group of beneficiaries who aren’t working and can work without causing thousands to lose health insurance.