States’ Experiences Confirm Harmful Effects of Medicaid Work Requirements
End Notes
[1] For data availability reasons, we calculate the coverage loss percentage as the total cases terminated as of January 1, 2019 (18,164) as a share of the cases subject to the work requirement in September (after all four groups were phased in) plus the number of cases terminated effective September 1. This calculation approximates the reduction in January enrollment, compared to a counterfactual in which the work requirement had not been implemented. (Both the numerator and denominator likely include some people who would have left the program by January even absent the work requirement.) Arkansas Department of Human Services, “Arkansas Works Program: December 2018,” January 15, 2019, https://humanservices.arkansas.gov/images/uploads/011519_AWReport.pdf.
[2] New Hampshire Department of Health and Human Services, “DHHS Community Engagement Report: June 2019,” July 8, 2019, https://www.dhhs.nh.gov/medicaid/granite/documents/ga-ce-report-062019.pdf.
[3] Robin Erb, “Gretchen Whitmer Asks to Stop Michigan Medicaid Rules; 80,000 At Risk,” Bridge Michigan, February 25, 2020, https://www.bridgemi.com/michigan-health-watch/gretchen-whitmer-asks-stop-michigan-medicaid-work-rules-80000-risk.
[4] Rachel Garfield, Robin Rudowitz, and MaryBeth Musumeci, “Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses,” Kaiser Family Foundation, June 27, 2018, https://www.kff.org/medicaid/issue-brief/implications-of-a-medicaid-work-requirement-national-estimates-of-potential-coverage-losses/.
[5] The other states included in the study are Kentucky, Louisiana, and Texas. Benjamin Sommers et al., “Medicaid Work Requirements — Results from the First Year in Arkansas,” New England Journal of Medicine, June 2019, https://www.nejm.org/doi/full/10.1056/NEJMsr1901772.
[6] Dan Diamond, “Alex Azar’s confusing claim on Medicaid work requirements,” Politico, March 15, 2019, https://www.politico.com/newsletters/politico-pulse/2019/03/15/alex-azars-confusing-claim-on-medicaid-work-requirements-546844.
[7] Anuj Gangopadhyaya et al., “Medicaid Work Requirements in Arkansas,” Urban Institute, May 24, 2018, https://www.urban.org/research/publication/medicaid-work-requirements-arkansas; see also Sommers, op cit.
[8] Arkansas Department of Human Services, “ARWorks Reports,” https://humanservices.arkansas.gov/newsroom/toolkits.
[9] Rachel Garfield et al., “Understanding the Intersection of Medicaid and Work: What Does the Data Say?” Kaiser Family Foundation, August 8, 2019, https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work-what-does-the-data-say/.
[10] “With new work requirement, thousands lose Medicaid coverage in Arkansas,” PBS NewsHour, November 19, 2018, https://www.pbs.org/newshour/show/with-new-work-requirement-thousands-lose-medicaid-coverage-in-arkansas; Benjamin Hardy, “Locked out of Medicaid — Arkansas’s work requirement strips insurance from thousands of working people,” Arkansas Times, November 19, 2018, https://www.arktimes.com/arkansas/when-arkansas-works-doesnt/Content?oid=25890378.
[11] Caitlin Andrews and Nathan DeWitt, “For ‘medically frail,’ judge’s decision on Medicaid expansion work requirement comes as a relief,” Concord Monitor, August 3, 2019, https://www.concordmonitor.com/Penacook-NH-medical-frailty-exemption-difficulties-26880774.
[12] Margo Sanger-Katz, “Hate Paperwork? Medicaid Recipients Will Be Drowning in It,” New York Times, January 18, 2018, https://www.nytimes.com/2018/01/18/upshot/medicaid-enrollment-obstacles-kentucky-work-requirement.html.
[13] Sommers et al., 2019.
[14] Dave Solomon, “Spreading the word on Medicaid work requirement proves challenging,” Union Leader, June 16, 2019, https://www.unionleader.com/news/health/spreading-the-word-on-medicaid-work-requirement-proves-challenging/article_740b99e7-9f48-52d4-b2d8-030167e66af8.html; Jason Moon, “Confusing Letters, Frustrated Members: N.H.’s Medicaid Work Requirement Takes Effect,” New Hampshire Public Radio, June 18, 2019, https://www.nhpr.org/post/confusing-letters-frustrated-members-nhs-medicaid-work-requirement-takes-effect#stream/0.
[15] Benjamin Sommers et al., “Medicaid Work Requirements in Arkansas: Two-Year Impacts on Coverage, Employment, and Affordability of Care,” Health Affairs, September 2020, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00538
[16] MaryBeth Musumeci, Robin Rudowitz, and Cornelia Hall, “An Early Look at Implementation of Medicaid Work Requirements in Arkansas,” Kaiser Family Foundation, October 2018, http://files.kff.org/attachment/Issue-Brief-An-Early-Look-at-Implementation-of-Medicaid-Work-Requirements-in-Arkansas.
[17] New Hampshire Department of Health and Human Services, “Letter to Governor Sununu, President Soucy, and Speaker Shurtleff,” July 8, 2019, https://www.dhhs.nh.gov/medicaid/granite/documents/ga-ce-findings.pdf.
[18] Ethan DeWitt, “Now-disbanded Medicaid work requirement costs New Hampshire $187,000,” Concord Monitor, September 23, 2019, https://www.concordmonitor.com/Now-disbanded-Medicaid-work-requirement-cost-New-Hampshire-$187-000-28745556.
[19] Nicholas Bagley, “Opinion: Enforcing Work Requirements is a Waste,” The Detroit News, December 5, 2019, https://www.detroitnews.com/story/opinion/2019/12/05/opinion-enforcing-work-requirements-waste/2608089001/.
[20] Anuj Gangopadhyaya et al., “Under Medicaid work requirements, limited internet access in Arkansas may put coverage at risk,” Urban Institute, October 29, 2018, https://www.urban.org/urban-wire/under-medicaid-work-requirements-limited-internet-access-arkansas-may-put-coverage-risk. Data are for non-elderly, non-disabled Medicaid recipients aged 19-49, the population subject to the work requirement.
[21] Ian Hill and Emily Burroughs, “Lessons from Launching Medicaid Work Requirements in Arkansas,” Urban Institute, October 2019, https://www.urban.org/sites/default/files/publication/101113/lessons_from_launching_medicaid_work_requirements_in_arkansas.pdf.
[22] Arkansas Department of Human Services, “DHS Expanding Phone Reporting, Outreach for Arkansas Works Enrollees,” December 12, 2018, https://humanservices.arkansas.gov/newsroom/details/dhs-expanding-phone-reporting-outreach-for-arkansas-works-enrollees#:~:text=Enrollees%20also%20can%20call%201,80%20hours%20a%20month%20requirement.
[23] Hill and Burroughs, op cit.
[24] Jason Moon, “As Deadline Looms, Some Struggle to Submit Work Hours Online for New Medicaid Requirement,” New Hampshire Public Radio, July 3, 2019, https://www.nhpr.org/post/deadline-looms-some-struggle-submit-work-hours-online-new-medicaid-requirement#stream/0.
[25] Benjamin Hardy, “Medicaid advocate criticizes Arkansas Works’ email-only reporting for work requirements,” Arkansas Times, April 28, 2018, https://www.arktimes.com/ArkansasBlog/archives/2018/04/28/medicaid-advocate-criticizes-arkansas-works-email-only-reporting-for-work-requirements.
[26] CBPP, “Taking Away Medicaid for Not Meeting Work Requirements Harms People with Disabilities,” updated December 10, 2018, https://www.cbpp.org/sites/default/files/atoms/files/1-26-18health.pdf.
[27] Anna Bailey and Judith Solomon, “Medicaid Work Requirements Don’t Protect People With Disabilities,” CBPP, November 14, 2018, https://www.cbpp.org/research/health/medicaid-work-requirements-dont-protect-people-with-disabilities.
[28] MaryBeth Musumeci, “Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018,” Kaiser Family Foundation, June 11, 2019, https://www.kff.org/medicaid/issue-brief/disability-and-technical-issues-were-key-barriers-to-meeting-arkansas-medicaid-work-and-reporting-requirements-in-2018/.
[29] Leighton Ku and Erika Steinmetz, “Bridging the Gap: Continuity and Quality of Coverage in Medicaid,” Association for Community Health Plans, September 10, 2013, http://www.communityplans.net/Portals/0/Policy/Medicaid/GW%20Continuity%20Report%20%209-10-13.pdf.
[30] Sommers et al., 2020.
[31] Hill and Burroughs, op. cit.
[32] Ian Hill, Emily Burroughs, and Gina Adams, “New Hampshire’s Experience with Medicaid Work Requirements: New Strategies, Similar Results,” Urban Institute, February 2020, https://www.urban.org/sites/default/files/publication/101657/new_hampshires_experience_with_medicaid_work_requirements_v2_0_7.pdf.
[33] Sommers et al., 2019, and Sommers et al., 2020.
[34] Arkansas Department of Human Services, ARWorks Reports, op cit.
[35] MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, “Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees,” Kaiser Family Foundation, December 18, 2018, https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of-enrollees/.
[36] LaDonna Pavetti, “TANF Studies Show Work Requirement Proposals for Other Programs Would Harm Millions, Do Little to Increase Work,” CBPP, November 13, 2018, https://www.cbpp.org/research/family-income-support/tanf-studies-show-work-requirement-proposals-for-other-programs-would.
[37] Judith Solomon, “Medicaid Work Requirements Can’t Be Fixed,” CBPP, January 10, 2019, https://www.cbpp.org/research/health/medicaid-work-requirements-cant-be-fixed.