Real Motives for Medicaid Work Requirements?

Medicaid, the joint federal and state program that helps provide medical coverage for some low income individuals, is managed by individual states who have significant control over who is eligible for the program in their state.  Some states have begun to implement work requirements for Medicaid recipients, requiring that individuals work for a specified number of hours each month or they will lose their Medicaid benefits – as of December these policies have been approved in Kentucky, Indiana, Arkansas, New Hampshire, and Wisconsin.  Proponents of Medicaid work requirements claim that the implementation of work requirements will increase employment and will help enrollees become self-sufficient and will ultimately improve people’s well-being due to the positive impact that working has on mental health.

A common argument in favor of work requirements is that they would increase employment which is good for both the economy as well as for individuals.  However, the requirements are unlikely to have a significant impact on employment because a majority of Medicaid enrollees already work, and those who are unemployed have strong barriers to being able to work.  According to the Center on Budget and Policy Priorities, 60% of people enrolled in Medicaid are already working. Laziness or a lack of incentives is not why 40% of enrollees are not working, rather most of them are either in school, have an illness or disability that makes them unable to work, are taking care of a family member, or are currently searching for work.  Medicaid work requirements are not only unlikely to increase employment, but they may in fact reduce employment due to the positive impact that access to health insurance has on people’s ability to maintain a job.

An additional incentive for people to work is unnecessary and instead of improving people’s well-being, Medicaid work requirements will only increase their stress and create more barriers for Medicaid enrollment eligibility.  A significant number of people who should qualify for work exemptions will face administrative burdens to report the reasons they qualify for exemption, and many will lose coverage due to failure to overcome the documentation requirements.  Enrollees who already are working are also at risk of losing their health care coverage due to the documentation requirements which include monthly submissions of pay stubs or timesheets to prove compliance. Deadlines for proof of compliance, complex documentation, and administrative errors risk causing working Medicaid enrollees to lose their coverage.  Other working enrollees are at risk of losing coverage because they fail to meet the minimum requirements due to fluctuating job hours or seasonal employment. The increased red tape that follows the Medicaid work requirements will cause considerable stress for Medicaid enrollees and many will ultimately lose their coverage.

Given the lack of evidence that Medicaid work requirements are likely to increase employment or improve individuals’ well-being, the question arises as to the motivation for imposing these work requirements.  Are these requirements designed to reduce the number of people on Medicaid – or punish them for being poor?

By Ellen Bart

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