Dive Brief:
- Medicaid beneficiaries at risk of losing coverage due to work requirements are often managing multiple chronic conditions, especially older enrollees, according to research published Wednesday in JAMA.
- To find beneficiaries who could be disenrolled under work requirements enacted by the One Big Beautiful Bill Act, the study analyzed national survey data to determine health characteristics of Medicaid enrollees between the ages of 20 and 64 who worked less than 20 hours per week or were unemployed and not exempt from the work mandates.
- About 41% of these beneficiaries had three or more chronic conditions. The percent grew to over 66% for those between 50 and 64 years old.
Dive Insight:
One of the biggest Medicaid policy changes from the One Big Beautiful Bill Act signed into law in July are work requirements, which mandate some beneficiaries in the program log at least 80 hours of work, education or volunteer hours a month to stay eligible for the coverage. The CBO reported that about 5 million adults could lose Medicaid coverage from the new requirements.
Many beneficiaries at risk of disenrollment due to work mandates have health concerns, however, and losing coverage could worsen their outcomes, according to the JAMA study. The research, which included 344 participants, found more than 20% had conditions including dyslipidemia — abnormal levels of fats in the blood — obesity, hypertension, urinary incontinence, depression or arthritis.
More than 12% of beneficiaries used at least five prescription medications, with the number increasing to 19% among enrollees ages 50 to 64, the study found.
Work requirements do include exemptions for some groups, including pregnant women, those with a disability or dependent child, and people who are considered “medically frail.” However, even though many of these enrollees might be eligible for an exemption, they could struggle to get one because of documentation barriers or differences in states’ definitions of medical frailty, researchers wrote.
“If most at-risk Medicaid beneficiaries are disenrolled due to challenges documenting clinical conditions for work requirement exemption, which the Congressional Budget Office has projected, adverse clinical outcomes from losing coverage for chronic disease treatment and prevention are likely,” they wrote.
Medicaid work requirements are a controversial policy. Republicans argued the mandates will preserve access to the safety-net program for those who need it most, but opponents say work requirements frequently remove eligible enrollees who struggle to navigate the paperwork demands.
Studies have also shown the policies don’t improve employment outcomes, and most Medicaid beneficiaries already work or would likely qualify for an exception.
