How Medicaid Work Requirements Will Harm Children
When parents have health insurance, their children are more likely to be insured, research shows. That's a big reason why the Affordable Care Act's (ACA) expansion of Medicaid for parents and other adults significantly increased children's health coverage, helping drive the uninsured rate for children to a historic low of 4.5 percent in 2016 (see chart). Children also benefit from their parents' better access to care and health outcomes and from their families' increased financial security.
A new
Work Requirements Will Cause Parents to Lose Coverage
While some states' work requirement policies exempt parents, others do not, and in some states, parents are the primary or sole targets of these requirements.
In states that expanded Medicaid under the ACA, both parents and adults without children with incomes up to 138 percent of the federal poverty line are eligible for Medicaid. Among expansion states with approved work requirement policies,
In states that haven't expanded Medicaid, low-income parents are the primary target of work requirements, since adults without children are generally ineligible for Medicaid. What's more, many of these states' proposals will put parents in non-expansion states in a Catch-22. If they don't comply with the work requirements, they'll lose coverage. If they do comply, they're still likely to lose coverage, because their income would likely exceed their states' very low Medicaid eligibility thresholds.
For example,
Requiring work or work-related activities as a condition of Medicaid eligibility will also make it harder for parents to stay covered even if they are already working or are supposed to qualify for exemptions. In many low-wage jobs, hours are volatile and job loss is common, meaning that even parents who work substantial hours over the course of the year may fall short of state work requirements in a particular month. Work requirements also make it harder for parents to stay enrolled because they will have to provide paperwork documenting their compliance or eligibility for exemptions. Red tape and paperwork requirements have consistently proved to reduce enrollment in Medicaid.
Documentation requirements are likely be especially burdensome for parents of children with special health care needs. While they would qualify for exemptions from work requirements in most states, they would have to prove they're caring for a child with a disability or special health care need, adding one more burden for parents who already face major challenges and potentially compromising care for their child.
When Parents Lose Coverage, Children Get Hurt
When parents lose health insurance coverage, children get hurt.
Children are less likely to get the care they need. Most children in low-income families were already eligible for Medicaid before the implementation of the ACA. A recent study shows, however, that Medicaid enrollment increased disproportionately for children whose parents became newly eligible. More than 700,000 children in Medicaid expansion states gained coverage from 2013 to 2015 -- more than double the number of children in non-expansion states who gained coverage during this period. That's consistent with earlier evidence that gains in coverage for parents translate into gains in coverage for children. Research also confirms that gains in coverage for parents, and the associated gains for children, improve children's access to care. For example, increases in adult Medicaid eligibility are associated with a greater likelihood of children in low-income families receiving preventive care, according to a recent study, which finds that children are 29 percentage points more likely to have an annual well-child visit if their parents are enrolled in Medicaid. Unfortunately, undoing coverage gains for parents will likely undo gains for children as well.
Families are less financially secure. Losing coverage would also put children and their parents at risk of going without needed medical care and incurring significant medical debt for any care they do receive. Medicaid expansion led to a decrease in debts being sent to third-party collection agencies, and the share of low-income adults in
Children's health and development are at risk. Children's health and development relies in part on their parents' health and well-being, and a large and growing body of research shows Medicaid expansion has improved access to care and health for low-income adults. Low-income adults in
The potential loss of coverage for both children and their parents jeopardizes children's long-term health and development. Children losing coverage would lose access to various important health services under Medicaid's Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This benefit guarantees that children and adolescents under the age of 21 have access to a robust set of comprehensive and preventive health services, including regular well-child exams; hearing, vision, and dental screenings; and other services to treat physical, mental, and developmental illnesses and disabilities. The loss of EPSDT would be particularly harmful to children with special health care needs, as Medicaid serves as the sole source of coverage for over one-third of these children.
Medicaid coverage has a significant positive impact on children's health not only while they're enrolled, but also on their long-term outcomes. Children covered by Medicaid during their childhood have better health as adults, with fewer hospitalizations and emergency room visits, research shows. Moreover, children covered by Medicaid are more likely to graduate from high school and college, have higher wages, and pay more in taxes. Medicaid work requirements that cost parents their coverage will put low-income children's short- and long-term health-related gains at risk.
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