- A large proportion of enrollees in the 16 states that have applied to CMS to impose work requirements on their Medicaid enrollees already have jobs or are providing care for someone in their household, according to a new report from the Kaiser Family Foundation.
- The report concludes that up to 4.1 million Medicaid enrollees may lose their coverage due to work requirements.
- Many of them may lose coverage due to a lack of access to computers to fulfill mandatory reporting requirements, KFF said.
Some of the states using Medicaid work requirements, such as New Hampshire, Kentucky and Indiana, expanded Medicaid eligibility under the Affordable Care Act. Others, such as Arkansas, Alabama and Mississippi, have not expanded eligibility and are not expected to do so in the foreseeable future.
Work requirements have been controversial and haven't generally held up in court. Three states have had their proposals shot down, with the latest ruling coming last month against New Hampshire. The judge said then that HHS, in approving the state's plan, failed to consider the risk of beneficiaries losing coverage as a result of the requirements. He vacated the approval.
KFF concluded the work requirements, if fully implemented, would affect some 23.5 million Medicaid enrollees. Of those, 70% are under age 45, and nearly 30% are raising at least one child.
"The sort of guiding philosophy behind this was that these are able-bodied people who should be able to work and they shouldn't get health insurance for nothing," Sarah Somers, attorney for the National Health Law Program, told the Associated Press last month.
However, most of the Medicaid recipients already have jobs. According to KFF, 44% have full-time jobs and 19% work part time, although 53% say they worked full time in 2017, the most recent year for which data was available. Most of the waivers from the states require only part-time employment (20 hours or more a week).
Another 12% of Medicaid enrollees say they are not working because they are providing care to another family member who is ill or disabled, a situation that exempts them from most of the work requirements. Another 11% are not working due to a debilitating illness or disability, and 7% are not working because they are attending school. Again, both scenarios often mean exemption from the work requirement.
That leaves only 7% of this population — about 1.7 million people in total — who are not working because they can't find jobs or consider themselves retired. However, the KFF report concludes up to 4.1 million enrollees could wind up being dropped from the rolls. Many of the states are requiring Medicaid enrollees report their work hours or attempts to find work or job training via computer. But 26% of Medicaid enrollees say they have never used a computer, 25% say they do not use the Internet, and 40% say they don't use email.
Citing a previous report on the topic of Medicaid work requirements, KFF observed that "most disenrollment would be among individuals who would remain eligible but lose coverage due to new administrative burdens or red tape, and only a minority would lose eligibility due to not meeting new work requirements."