(T)wo new studies published today in JAMA Internal Medicine question the effectiveness of and rationale for such work requirements, finding that the vast majority of Medicaid recipients already work or would be exempt for reasons such as pregnancy or disability. Because only a small number of beneficiaries would be affected, budgetary savings through any reduction in the rolls would be minimal.
“Medicaid work requirements are out of step with the lived experiences of low-income people … [and] represent a case of policymaking gone astray, causing more harm than good,” wrote Dave Chokshi, a professor of population health at New York University, and Mitchell Katz, deputy editor of JAMA Internal Medicine, in a commentary accompanying the two studies.
One of the studies, led by David M. Silvestri of the Yale School of Medicine, used data on household income, employment and utilization of government assistance programs from the U.S. Census to determine the number of people who would be subject to the new work requirements in each of the 11 states that applied for federal waivers. They found that only between 0.3 percent and 5.4 percent of people who were eligible for Medicaid in these states would be affected — in large part because so many in the program already work.
The second study, led by Anna L. Goldman of the Cambridge Health Alliance and Harvard’s School of Public Health, estimated changes in Medicaid enrollment and expenditures if the work requirements and the exemptions common to all of the approved state waivers to date (those from Kentucky, Indiana, Arkansas, and New Hampshire) were applied on a national scale.
The Goldman study found that 2.1 million current beneficiaries would be at risk of losing their coverage nationally. This amounts to only 2.8 percent of all people in the program, spending on whom accounts for just 0.7 percent of current Medicaid expenses.
The study’s authors cautioned, however, that there could be a substantial “spillover” effect: Medicaid enrollees who fulfill the work requirement or should be legally exempt may lose their coverage due to trouble meeting new documentation rules. This is because in states instituting the work requirements, all Medicaid recipients — even those who already work or qualify for exemptions — will be required to regularly report their work hours or reasons for exemption, sometimes as often as monthly.
