BEYOND THE NUMBERS
West Virginia’s House is expected to vote today on House Bill 3136, which would likely take Medicaid coverage away from at least 46,000 non-elderly adults who can’t meet proposed work requirements.
The bill would require all of the state’s non-elderly adult Medicaid beneficiaries to document 20 hours of work, education, substance use treatment, or volunteer activities each week (or 80 hours a month) to maintain their health coverage, unless they qualify for an exemption. These requirements are harsher than what’s in place in Arkansas, where more than 18,000 people — 23 percent of those subject to the requirement — have lost their health coverage since the policy took effect there in June 2018.
Since 201,000 non-elderly adults would be subject to West Virginia’s requirement, at least 46,000 people would likely lose their Medicaid coverage due to HB 3136. The overwhelming majority of them would become uninsured.
That projection, in fact, likely underestimates the potential coverage loss in West Virginia. That’s because HB 3136 is even harsher than Arkansas’ policy. In West Virginia, beneficiaries would lose coverage if they don’t meet the hours requirement in just one month, while in Arkansas a person can fail to meet the requirement in three months in a calendar year before losing their coverage. In addition, West Virginia’s bill would apply the requirement to adults up to age 64, versus age 49 in Arkansas: older Medicaid enrollees are less likely to work (largely because they face greater health challenges), which means they would more likely lose coverage.
Arkansas also uses available state data to exempt a large share of beneficiaries from having to report or claim an exemption, while HB 3136 says nothing about how West Virginia will determine exemptions and compliance. In an analysis of Michigan’s work requirement policy, Manatt Health projected that without automatic exemptions like Arkansas’, a significantly larger share of people would lose coverage. Also of note, 23 percent of Arkansas beneficiaries subject to the requirement lost their coverage in just the first seven months of the policy: coverage loss rates will almost certainly rise over time.
Arkansas’ experience shows that many of those who have lost coverage are working or have serious health needs and have trouble overcoming the red tape that these policies create. That’s an unavoidable consequence of any work requirement proposal, as we’ve explained.
Among those at particular risk of losing coverage in West Virginia are:
Working people with unstable jobs. In West Virginia, more than half of adults with Medicaid are already working, but the most common jobs are in restaurants and food service. Low-wage jobs like these feature volatile hours and little flexibility, meaning that any illness or family emergency can lead to job loss and periods of unemployment. That’s why our analysis found that, nationwide, nearly half of working low-income adults potentially subject to Medicaid work requirements wouldn’t be able to meet a 20-hour-per-week standard every month.
By taking away health coverage from working people with unstable jobs, West Virginia’s policy might leave fewer people working. In surveys of beneficiaries in Michigan and Ohio, beneficiaries with jobs who gained coverage under the Affordable Care Act’s Medicaid expansion said that their Medicaid coverage has made it easier for them to maintain employment, while those without jobs said coverage made it easier for them to look for employment. Having access to regular care, like prescriptions to control chronic conditions, makes it easier to look for or hold a job; taking away access to care can make it nearly impossible.
People with disabilities and other serious health needs. Among West Virginia’s adult Medicaid enrollees who aren’t already working, many report a work-limiting disability or other serious health condition. Exemptions won’t protect this group from losing coverage. In fact, studies of state Temporary Assistance for Needy Families (TANF, or cash assistance) programs and SNAP (food stamps) have found that people with disabilities, serious illnesses, and substance use disorders are disproportionately likely to lose benefits, even when they should be exempt. And when they lose coverage, the harm to their health is especially great. As the American Medical Association, the Catholic Hospital Association, and other provider and patient organizations recently wrote, “Discontinuing coverage for patients who have already been diagnosed with cancer or another chronic disease can be nothing short of catastrophic. . . . This care saves lives. Uninsured patients with cancer, diabetes, and heart disease have much worse survival rates than insured patients suffering from the same diseases.”
Taking away coverage from people with serious health needs will also likely drive up uncompensated care and emergency room use. Evidence suggests that expansion coverage leads to more appropriate use of care by increasing the use of primary care services and reducing emergency room visits by the uninsured.
- People struggling with substance use disorders. West Virginia has been particularly hard hit by the opioid crisis; it has the highest rate of drug overdose deaths in the country. In West Virginia and elsewhere, Medicaid provides access to care for people with opioid use and other substance use disorders. Medicaid makes medications like buprenorphine and naloxone, which are prescribed to combat opioid use disorders, affordable for beneficiaries. While HB 3136 allows substance use treatment to count as a qualifying activity to meet the work requirement, people struggling with substance use disorders are especially poorly positioned to complete reporting and documentation requirements; nor are most in treatment for the required 20 hours per week even if they’re getting help. That means the bill would almost certainly reduce the number of West Virginians receiving treatment for opioid use disorders, worsening the state’s epidemic.