Requiring poor people to work to get Medicaid isn’t working, study says

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The first attempt by a U.S. state to make poor people get jobs in order to qualify for Medicaid health insurance is having a troubling result, a new peer-reviewed study shows: It isn’t boosting employment, and it’s leaving more low-income residents without health care coverage.

The New England Journal of Medicine published a study last week evaluating Arkansas, the first state to impose the Medicaid work requirement last fall. Medicaid is the state-federal health care program for the poor and disabled. More than 17,000 Arkansas residents lost their Medicaid coverage after the state required able-bodied adults between the ages of 30 and 49 to work. Advocates for the needy say imposing a work requirement can be tough on families who are living below the poverty level, earning extremely low wages, and can’t afford child care and transportation.

In March, a federal judge struck down the Arkansas Medicaid-work requirement and a similar program in Kentucky. The Trump administration had given those two states and eight others a “waiver” from federal regulations to impose the work requirement. Six other states are awaiting federal approval to move forward with similar Medicaid-work plans.

In Florida, the state House passed a bill in the 2019 session that would have required non-disabled adults to work or to participate in education or community service activities in order to receive Medicaid. Analysts estimated the measure would have threatened the eligibility of some 500,000 Florida residents who participate in Medicaid. The Florida Senate never considered the measure, killing the proposal for this year. However, when state lawmakers return in January for their 2020 session, the Medicaid-work legislation is likely to re-emerge.

The New England Journal of Medicine study showed the number of Arkansans between the ages of 30 and 49 who were eligible for Medicaid but ended up without insurance rose from 10.5 percent in 2016 to 14.5 percent in 2018. Meanwhile, the employment rate for those residents fell from 42 percent to below 39 percent.

The study cited a “lack of awareness and confusion about the reporting requirements” as reasons why eligible Medicaid recipients lost their coverage after the work requirement took effect.


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