Promising Montana Program Offers Services to Help Medicaid Enrollees Succeed in the Workforce
A number of states are implementing or considering policies that would take Medicaid coverage away from enrollees not working a specified number of hours each month. Such work requirements are unlikely to promote employment and may be counterproductive: research in other programs has shown that conditioning basic assistance on work is unlikely to increase long-term employment rates or incomes,(1) and taking away health coverage and access to care is likely to be harmful and may impede employment for some.(2)
Unlike
Montana HELP-Link's Comprehensive Enrollee Engagement
When
HELP-Link dedicates significant effort to outreach strategies targeting Medicaid enrollees who may benefit from its services. All newly eligible Medicaid beneficiaries are automatically surveyed about their employment and barriers to work at the point of enrollment and are provided information about HELP-Link workforce programs. The state also sends letters to all Medicaid expansion enrollees about the availabilities of these services.
State workers analyze the surveys completed by individuals who have not yet engaged in training and make outreach calls to offer personalized assistance based on the barriers and needs that each person identified. According to the state, 14,000 individuals have received these outreach calls.
Enrollees who are interested in enrolling in HELP-Link make an appointment for an in-person assessment with a case manager and complete an individualized employment plan that includes suggested training based on the person's goals. Once enrolled, participants in HELP-Link can access a wide range of services, such as job seeker workshops and information regarding high-demand sectors. The state also offers significant tuition assistance to individuals interested in enrolling in training for high-demand careers such as health care or manufacturing.
HELP-Link also collaborates with community organizations to provide training for enrollees beyond what the
In addition to career services, HELP-Link provides referrals to other state agencies' services, such as home health aides, child care, and housing, for those with additional barriers to work.(4) Research increasingly shows that the most effective employment programs offer a combination of training and supportive services. Many low-income individuals don't have the resources to cover child care or transportation costs or to purchase clothes they may need for work. Supportive services can fill these gaps and allow people to succeed at work.(5)
The HELP-Link program demonstrates that many Medicaid enrollees who aren't working but can work will take advantage of employment services when offered. According to the state, of those who completed HELP-Link surveys, 65 percent went on to receive direct services from staff. In total, 22,000 Montanans have enrolled and received employment services in the program's first three years.(6) While that figure may seem small compared to
Moreover, while the causal impact of the HELP-Link program on employment and wages has not been evaluated, the state reports that HELP-Link participants have high employment rates and are entering high-demand occupations such as registered nurses, nursing assistants, heavy and tractor-trailer truck drivers, and medical record and health information technicians.
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Other states may also have unrealistic expectations for the share of enrollees who should be participating in a successful workforce program. As in
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Work requirements will also likely result in coverage losses among people who are already working substantial hours, but at unstable jobs in industries like retail, restaurant work, home health, and construction where hours fluctuate from month to month and workers often end up with gaps between jobs. Among low-income workers who could be affected by Medicaid work requirements and who worked at least 1,000 hours over the course of a year (more than 80 hours per month on average), 1 in 4 would have been at risk of seeing an interruption in coverage or losing it altogether under an 80-hour-per-month work requirement policy like
In addition to the harmful impact that losing coverage has on health, health coverage is an important work support. Having health care helps people work and look for work, and taking it away will likely make it harder for some to keep and find work. For example, among non-working adults gaining coverage through the ACA's Medicaid expansion in
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(9) Healthy Indiana Plan Section 1115 Waiver Amendment to Extension,
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