How Medicaid Work Requirements Could Impact Low-Income Women

As policymakers decide the fate of Medicaid work requirements, the impacts of these policies are becoming more clear, particularly their effects on low-income women, a Kaiser Family Foundation (KFF) issue brief found.

“Women are more likely to qualify for Medicaid than men because they have lower incomes and have been more likely to qualify under one of Medicaid’s traditional eligibility categories: pregnant, parent of a child under 18, disabled, or being over 65,” the issue brief noted.

“Additionally, the COVID-19 pandemic has increased barriers to work and fueled massive unemployment, particularly in industries that employ significant shares of low-income women of color, who comprise a disproportionate share of Medicaid enrollees.”

In 2019, most people in Medicaid were employed. Nearly 60 percent of female Medicaid beneficiaries and almost 70 percent of male Medicaid beneficiaries had a job. More than three in ten women (35 percent) who were on Medicaid worked full-time in 2019 and 24 percent worked part-time. Another 41 percent of female Medicaid beneficiaries did not work.

For those who were the exception to this standard, there were various reasons why women on Medicaid did not work. The most common explanations were that these women were caregivers, had an illness or disability preventing them from working, or were in school.

Almost 50 percent of women stated that they taking care of their family or home was the reason that they were not working, compared to ten percent of men who said the same. Nearly three-quarters of women with children under the age of 18 reported that they were not working due to family responsibilities.

Of the women who did not have children, illness or disability was the primary cause of not working.

For men, disability or illness were the most common reason for not working, both among fathers and among those without children. A little over one-quarter of men with children under the age of 18 stated that they were not working due to responsibilities at home.

Among states that have implemented work requirements or have submitted plans to implement work requirements, the exemption standards vary. Some states have exemptions for parents with children under 18 whereas other states will only make allowances for parents of children under a year old.

Having employment does not necessarily mean that an individual has health insurance. For many in the Medicaid program, their jobs do not provide health insurance coverage.

Three of the top ten industries that women in Medicaid worked in were: restaurants and other food services elementary and secondary schools, and home healthcare services. Three of the top ten occupations were: cashiers, maids and housekeeping cleaners, and waiters and waitresses.

Importantly, the issue brief’s data predated the coronavirus pandemic’s unemployment spike. Indeed, Utah officials suspended the state’s work requirements due to the challenging job market.

The pandemic hit employment among women—specifically, low-income women of color—particularly hard. In April 2020, when the overall unemployment rate was at 14.7 percent, the unemployment rate among Black women was 16.4 percent and among Latinas the rate was 20.2 percent, according to the National Women’s Law Center.

Some of these jobs came back due to the widespread practice of furloughing and the reopening of the economy in the second half of 2020. The event highlighted, however, how vulnerable women’s employment can be.

Medicaid work requirements have already been linked to coverage losses in scenarios such as Arkansas’s Medicaid work requirements program. In Arkansas’s case, those losses were primarily due to confusion over the policy.

The issue brief is timely because the Biden administration has signaled that it intends to rescind Medicaid work requirements. The administration noted not only the unstable work environment that the pandemic has caused, but also due to the threat of coverage loss.

“Although that statutory bar will expire after the COVID-19 public health emergency ends, CMS has serious concerns about testing policies that create a risk of a substantial loss of health care coverage in the near term,” acting CMS Administrator Elizabeth Richter said in a letter to Wisconsin’s Medicaid director, explaining why the agency had decided to rescind its approval of the state’s work requirements program.

The data demonstrates that there are distinct differences in work status between men and women in the Medicaid program and between mothers and those who are not parents.