Medicaid Work Requirements Compromise Access to Healthcare

The COVID-19 public health emergency has ended, and with it has ended the continuous enrollment provision in Medicaid programs. Additionally, “able-bodied adults with no dependents” (ABAWDs) enrolled in Medicaid are included in the debt-ceiling negotiations that are ongoing in Washington. Along with Medicaid, Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) enrollees will be required to work or perform community engagement activities for 80 hours each month to remain enrolled in these programs.

The wheels for implementation have already been turning: a bill passed by the House of Representatives will require those seeking exemption from the work requirement to be evaluated by a healthcare professional.

Lack of Success with Medicaid Work Requirements 

The argument for requiring those enrolled in Medicaid to work a minimum number of hours per month is that it will improve beneficiary health and also raise them above poverty levels. However, a review of this policy in Arkansas—the first state to enforce Medicaid work requirements for adults 30-49 years old in 2018—found that after two years:

  • Employment had not increased 
  • Among the 30–49-year-olds who were disenrolled from Medicaid in the prior year:
    • 50% could not pay off their medical debt
    • 56% delayed getting care because of cost
    • 64% delayed taking medications because it’d be expensive

Lack of awareness about the policy being enforced along with the reporting burden may have led to the 18,000 adults losing coverage during the ten months that the policy was active. Federal courts forced the state to stop the work requirements.

According to the Department of Health and Human Services, 21 million Medicaid enrollees in the 19–55-year age bracket risk losing Medicaid coverage if they are forced to navigate the reporting system: either adherence to work requirement or the need for exemption. This will eventually lead to poor health care outcomes.

Most Medicaid Enrollees Are Already Working

Survey data show that >60% of non-elderly, non-disabled adults who are on Medicaid are already working either full-time or part-time. Most of the remaining 40% are unable to work because of illness or disability, are caregivers, or are students, which means they would qualify to be exempt from working. However, sustaining their employment is often problematic because of issues with transportation, internet access, dynamic work schedules, and their personal health status.

If these vulnerable populations lose access to their Medicaid coverage and SNAP benefits because of burdensome Medicaid work requirements, it’ll put them further back with their health and life.

Surabhi Dangi-Garimella, Ph.D. is a biologist who provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.

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Surabhi Dangi Garamella

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