Implications of Work Requirements in Medicaid: What Does the Data Say? – Kaiser Family Foundation

Food insecurity is high among both working and non-working adults with #Medicaid. Nearly a third (31%) of working and 37% of non-working Medicaid adults say they sometimes or often worry that food will run out.

In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for state Medicaid waiver proposals that would impose work requirements in Medicaid as a condition of eligibility. As of June 2018, four states have approved waivers to implement Medicaid work requirements, seven states have waiver requests pending with CMS, and other states are considering or developing work requirement programs. These states are all imposing or seeking to impose work requirements on populations already covered (both expansion and non-expansion populations); however, Virginia passed legislation to adopt the Medicaid expansion that included a provision to submit a waiver to impose a work requirement on a new expansion population. This brief builds on previous analyses to provide data on Medicaid enrollees and some of the policy implications of work requirements. Key findings include:

Only 6% of adult #Medicaid enrollees targeted by states’ new #workrequirements are not already working and are unlikely to qualify for an exemption.

Most Medicaid enrollees who can work are already working but could face barriers in complying with reporting requirements. More than six in ten adult enrollees are working. Those in excellent/very good health are almost twice as likely to work as those in fair/poor health. Having higher education is also positively associated with whether someone works. However, since one in three Medicaid adults never use a computer or the internet and four in ten do not use email, many enrollees would face barriers in complying with work reporting requirements to maintain coverage.
Paid work can help provide family resources, but low-wage and part-time work may not be sufficient to overcome poverty. Most working Medicaid enrollees are working full-time for the full year and are working in low-wage service jobs with limited benefits such as sick time or health coverage. Most Medicaid workers (78%) are paid hourly, and 36% of these hourly workers earn a wage at or below $10/hour. Even when working, adults with Medicaid face high rates of financial insecurity. In non-expansion states with low eligibility levels for adults, working part time at minimum wage would lead to loss of Medicaid without access to coverage through the ACA marketplaces.
Many Medicaid enrollees who are not working could be exempt from work requirements but would still need to navigate an exemption process. A quarter of non-working Medicaid adults without SSI have mobility or physical limitations such as difficulty going up or down stairs (24%), walking 100 yards (25%), sitting or standing for extended periods (27%), or stooping, kneeling or bending (24%). Many live with daily, activity-limiting pain. Among the “able bodied,” or those in good health or better, most say the reason they are not working is because they are taking care of home or family or are in school.
A small share (6%) of adult Medicaid enrollees are not already working and unlikely to meet an exemption and thus are the stated target of work requirements. However, systems to track work reporting and to process exemptions would apply to much larger shares of enrollees, both workers and those seeking exemptions. States will be required by CMS to describe strategies to assist beneficiaries in meeting work requirements but may not use federal Medicaid funds for supportive services to help people overcome barriers to work.

Are most Medicaid enrollees working?

Most Medicaid enrollees who can work are already working. Overall, more than six in ten non-dual, non-SSI, nonelderly adults with Medicaid work (Figure 1). Adults in excellent/very good health are nearly twice as likely to be working as those in fair/poor health. Not surprisingly, Medicaid adults with higher education levels are more likely to work. Medicaid adults with a high school degree (58%), some college (64%), or a college degree (69%) were significantly more likely to be working than those who did not have a high school diploma (51%). Although “work readiness” encompasses a range of factors, including social/behavioral skills, technical skills, “soft skills,” and others,¹^,² having a high school diploma is a basic requirement for many jobs.

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