1 in 3 working adults could lose Medicaid under work requirements

A new analysis shows one in three adults who work or attend school while enrolled in Medicaid expansion coverage would still be at risk of losing coverage under work requirements in the House-passed budget bill now being considered by the Senate. The analysis was prepared by the Urban Institute with support from the Robert Wood Johnson Foundation.

Researchers say these individuals would fail to meet the letter of the law due to the unstable nature of some employment—like service workers without consistent hours and those who experience seasonal layoffs. Among the 31% of enrollees in expanded Medicaid programs who do not work or attend school, more than two-thirds (21%) are not working because of a health condition, disability, caregiving responsibilities, or difficulty finding employment. Only 2% of expansion enrollees do not work or attend school and cite lack of interest as a reason for not working, according to the findings. These enrollees constitute a small fraction of the 4.8 to 6 million adults projected to lose coverage under the policy.

The analysis notes that imposing work requirements as a condition of initial Medicaid enrollment, as the bill currently does, would reduce enrollment among adults who seek Medicaid coverage because of job loss. The analysis shows nearly one in six adults (16%) experience a job loss during the six months prior to or the month of applying for Medicaid.

“Though proponents of a Medicaid work requirement claim it would only deny health insurance coverage to people who can work and choose not to, the policy could actually block a much larger number of working people from Medicaid coverage,” said Michael Karpman, principal research associate at the Urban Institute. “Workers at high risk of being denied Medicaid include those who experience job loss, have temporary jobs or unstable work schedules, or have health conditions or caregiving responsibilities that affect their ability to work consistently.”

“Work requirements for Medicaid or any safety net programs would be a disaster in practice,” said Gina Hijjawi, senior program officer at the Robert Wood Johnson Foundation. “The overwhelming number of Medicaid enrollees who are not working do not choose to be out of the workforce. They are disabled, care for an aging or disabled loved one, live with a serious health condition, lost a seasonal job, are enrolled in school, or can’t find steady employment. The bill is punitive, denying healthcare coverage to people for reasons that are simply inaccurate and more often than not, out of their control. Most people receiving Medicaid are in fact working but are not offered health insurance through work or simply do not make enough money to purchase private health insurance. The bill punishes hardworking people for not making enough money.”

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Read the full analysis.