Study finds most Medicaid beneficiaries already work or can’t work; many of those out of work are in poor health

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Arkansas is one of a number of states that has proposed work requirements for its Medicaid expansion program. The state is currently awaiting federal approval for its proposed changes, and while some of its requests remain up in the air, the Trump administration has given every indication that it will approve the work requirements.

Such requirements add bureaucratic complexity to the program and create additional hoops for beneficiaries that could lead to gaps in coverage. But this is an irresistible talking point for Republicans, of course: Get a job, moochers!

Research conducted on Michigan’s Medicaid expansion program by the University of Michigan Institute for Healthcare Policy and Innovation and published yesterday in JAMA, however, raises some questions about the familiar talking point. Researchers found that most beneficiaries in Michigan are either working already (49 percent) or unable to work (28 percent — typically because of serious physical or mental health impairments).  Another 12 percent were either students, retired or homemakers — people we wouldn’t expect to be working, and in many cases would be exempt from the proposed requirements.

That leaves around a quarter of beneficiaries who are out of work — this would be the group that work requirements are supposed to target. But researchers found that this group is much more likely to be in poor health: 

* Two-thirds of those out of work said they had a chronic physical illness

* 35 percent said they had been diagnosed with a mental illness.

* One-quarter of those out of work said they had a physical or mental impairment that interfered with their ability to function at least half the days in the past month.

Remember, Medicaid is a health care program, not a jobs program; adding bureaucratic hurdles for this group could disrupt care for those who need it most. Gov. Hutchinson’s proposal would lock them out of coverage for the rest of the year if they failed to comply.

From the University of Michigan’s Health Lab blog:

“The question raised by these data for states is: Is it worth the cost to screen and track enrollees when only a small minority isn’t working who are potentially able to work?” says Renuka Tipirneni, M.D., M.Sc., lead author of the study and a clinical lecturer in general internal medicine at U-M.

“Even if they don’t meet federal disability criteria, our survey shows many of these individuals face significant health challenges,” she adds. “It’s also important to consider that dropping them from coverage for failure to fulfill a work requirement could seriously impact their ability to receive care for chronic physical and mental health conditions that can worsen without treatment.”

A recent issue brief from the Kaiser Foundation summarizes other research on work requirements:

* Among Medicaid adults (including parents and childless adults — the group targeted by the Medicaid expansion), nearly 8 in 10 live in working families, and a majority are working themselves. Nearly half of working Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored insurance offer rates.

* Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities.

* While proponents of work requirements say such provisions aim to promote work for those who are not working, these policies could have negative implications on many who are working or exempt from the requirements. For example, coverage for working or exempt enrollees may be at risk if enrollees face administrative obstacles in verifying their work status or documenting an exemption.

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