Report: Work Requirements Would Threaten Coverage for One Third of Medicaid Recipients

Jul 6, 2017

Work requirements under the federal health insurance program Medicaid are based on a simple premise: If you want to receive government assistance for your healthcare and you’re able to work, you should work.

In recent years the federal government has told states like New Hampshire that they can’t impose work requirements for Medicaid recipients. But with Republicans in charge in Washington, D.C., states may find a more favorable climate for passing work requirements.

A new report from the Carsey School of Public Policy at UNH takes a look at who might be affected by work requirements. Jessica Carson, coauthor on the report, spoke with NHPR’s Peter Biello.

These work requirements, even if they are imposed some day, would still exempt certain people, and allow them to receive Medicaid without working. Who are  those groups?

That’s correct. The features of possible work requirements vary from state to state, but in our analysis, we assumed the policies would affect non-elderly adults who are not working at least twenty hours a week year-round, or who are not enrolled in school, or who are not caring for their own child under age six.

About 70 percent of people would not be affected by the work requirements as we envision them here, so we’re talking about 3 in 10 folks would be affected by the potential requirement.

What are the conditions of their lives, this 30 percent, that make their status as a Medicaid recipient vulnerable under a hypothetical work requirement?

Broadly speaking, most of the folks who would be potentially affected by a work requirement are already working in some capacity, or were seeking work in the past year. About 80 percent of these folks either were working some but not quite enough to reach the part-time requirement, or they were already seeking work but were unable to find it.

So those folks would technically meet the work requirement, and would therefore be ineligible for Medicaid.

So folks who are looking for work and unable to find it would be affected?


What about people who are caring for, say, a family member, and they are unable to find work because of the demands of that care? Would those people be burdened by a work requirement?

The specific features do vary state to state, but in this analysis, we assumed that folks who have a child under 6 years old in the household with them, their own child, would be excluded from the work requirement. But people who are caring for another person in the household who is not under 6, they would be subjected to a work requirement in many states.

For example, we could be talking about a single mother who is caring for an older child with a disability, or a person who’s caring for aging parents in the household, and the burdens of caring for another person could make them unable to meet the work requirement.

You broke this down by rural and urban areas. Did you find any difference? Are people in either type of area more or less vulnerable to changes in their Medicaid status under a work requirement?

One of our big takeaways here was that, actually, rural and urban folks seem to be about equally vulnerable to this. This is a big issue in rural places, too, so we wanted to make sure to highlight that.

One difference that did emerge is that there’s a slightly higher share of the potentially impacted group who were working or looking for work in rural places. It’s slightly over 80 percent in rural places and slightly under 80 percent in urban places. Not a huge difference, but there’s a bit of a difference there, which could indicate that people in rural places are not working because there’s a lack of opportunity there that doesn’t exist in rural places.

In both rural and urban areas, a large portion of Medicaid recipients said they only worked part of the year, and those folks could be impacted by a hypothetical work requirement. Can you tell us about this group and what kind of challenges they could face?

For part year employees, there’s a lot of variability within that group, but in rural areas those are people who maybe work seasonally, in agriculture for example, where harvests are only applicable during part of the year. So those people would fall into that working part-year category.

Your report also mentions that states like New Hampshire should be mindful of the administrative costs associated with a work requirement. For example, the state might have to keep track of how much people are working, and that would require hiring monitors.

Absolutely, and that’s particularly relevant when we’re talking about a low-income population who may face a lot of instability across the year. So tracking when folks are in and out of jobs or above and below certain hours thresholds could be cumbersome from an administrative standpoint.

In the course of your research, did it strike you that these numbers were particularly telling for a state like New Hampshire? Did it present an accurate picture, in your view, of what might happen in New Hampshire under a work requirement?

Our work actually didn’t have state by state breakdowns, but given our analysis shows strong similarity between the working activity of Medicaid recipients in rural and urban places, and given that New Hampshire has an especially low unemployment rate, we don’t have any reason to expect that the overall takeaways would be less relevant to a state like New Hampshire as whole.