Medicaid Work Requirements Could Disrupt Coverage Access for 21M People

Around 21 million Americans could face barriers to health insurance coverage if Congress passes the debt ceiling bill that includes Medicaid work requirements, according to an analysis from the US Department of Health and Human Services (HHS).

Medicaid work requirements are generally in the form of a waiver and can vary by state. They require beneficiaries to work a certain number of hours per week or actively search for a job to retain Medicaid coverage. Individuals may be exempt from work requirements if they are medically frail, pregnant, or a parent to a dependent child.

Republicans in the House of Representatives have proposed a bill to increase the government’s debt ceiling. One of the provisions in the bill includes implementing Medicaid work requirements.

The HHS analysis used data from the Centers for Medicare and Medicaid Services (CMS) to estimate the effect of Medicaid work requirements on states that have expanded Medicaid. The data represents Medicaid beneficiaries ages 19 to 55 who were not enrolled via disability, parent/caretaker, or pregnancy-related eligibility pathways.

Across all Medicaid expansion states, over 21 million beneficiaries could potentially be subject to work reporting requirements.

HHS also provided fact sheets with county-level analyses for the five most populous expansion states: California, New York, Pennsylvania, Illinois, and Ohio.

In California alone, around 4 million beneficiaries could be at risk of losing Medicaid coverage, with 1.2 million people at risk in Los Angeles County. Over 2.3 million people could lose coverage in New York, with Kings County residents seeing the highest potential coverage losses at 446,000.

Around 1.4 million beneficiaries in Illinois, one million in Pennsylvania, and almost 900,000 in Ohio could potentially lose Medicaid coverage if work requirements are implemented.

In 2018, the Trump Administration encouraged states to request Section 1115 waivers that impose Medicaid work requirements. Under the Trump Administration, CMS approved waivers in 13 states, but one state, Arkansas, implemented the work requirements.

The waiver in Arkansas was in effect from June 2018 to March 2019. Data has suggested that more than 18,000 people, or about 25 percent of those subject to the requirement, lost coverage in 2018. Beneficiaries who lost Medicaid in 2018 could reapply for coverage in January 2019, but 89 percent remained unenrolled in early 2019.

According to HHS, more than 95 percent of beneficiaries subject to the requirements had already met the requirements or should have qualified for an exemption.

While a goal of Medicaid work requirements is to boost employment, Arkansas’ implementation led to coverage losses and showed no evidence of increased employment, HHS said.

The House recently voted to pass the debt ceiling bill, but the measure is not expected to make it through the Senate. Additionally, President Biden has stated that he would veto the bill if it reached his desk.