Analysis Finds That Most Medicaid Enrollees Who Can Work Already Do

Work requirements for Medicaid—which stipulate that working-age adults either work or be engaged in job searches, volunteering, training, school, or health education in order to be eligible for Medicaid—have been newly implemented in Arkansas. As of June 2018, Kentucky, Indiana, and New Hampshire have also received approval to implement work requirements, and Arizona, Utah, Kansas, Mississippi, Ohio, Wisconsin, and Maine all have applications pending. Despite enthusiasm for work provisions, a new analysis from the Kaiser Family Foundation finds that most Medicaid enrollees who are able to work are already employed, and that work requirements are unlikely to help enrollees rise from poverty, and could negatively impact enrollees who are already working or who are unable to work because of medical conditions.

According to the analysis, 62% of nonelderly adults who are not receiving Supplemental Security Income and are not eligible for both Medicare and Medicaid are already working, with 43% working full time and 19% working part time. A further 18% are not working but are in a working family. Enrollees who are in very good or excellent health are nearly twice as likely to be working than those in fair or poor health.

Even though the majority (51%) of those enrollees who work are employed full-time for the full year, their annual incomes are still low enough that they qualify for Medicaid. Among those enrollees who are employed part time, many (10%) report that they are unable to find full-time work, and approximately 10% of enrollees work in more than 1 job.

Workers who are eligible for Medicaid earn low wages; most workers (78%) are paid hourly, and 36% earn a wage of $10 per hour or less. Even though an individual working full time at the federal minimum wage would earn just over $15,000 per year, the analysis points out, under Kansas and Mississippi’s work proposed plans, such employment would result in ineligibility for Medicaid due to earnings, trapping workers in jobs that leave them below the poverty level and without health coverage benefits or paid sick days, despite the fact that beneficiaries often work in physically demanding jobs such as nursing, cleaning, and driving.

Adding to challenges for enrollees is the difficulty that many face, complying with requirements for reporting their work. Under Arkansas’ new work program, beneficiaries must set up online accounts to periodically report their qualifying work activities; there is no alternative reporting option. Importantly, 30% of Medicaid recipients report that they never use a computer, 28% report that they do not use the internet, and 41% report that they do not use email.

A further challenge for beneficiaries who are medically frail or disabled is gaining an exemption from the new requirements. Many beneficiaries whose ability to work is limited by a medical condition do not receive federal disability payments, so they are not automatically exempt from work requirements. These beneficiaries may have physical limitations—including pain, difficulty sitting or standing, or carrying objects—that restrict the kind of work that they could perform if employed. While many work requirement waivers indicate that they will exempt beneficiaries who are medically frail or disabled, it is unclear how states plan to implement those exemptions, and equally unclear whether those who qualify will be able to navigate the process for gaining such an exemption.

“People already working or exempt from new work requirement policies may not be the target of new policies,” write the authors of the analysis, “but they will still be subject to verifying work status or navigating an exemption process that could result in eligible individuals losing coverage at high administrative expense for states.”