- NC Policy Watch - http://www.ncpolicywatch.com -

New report: Medicaid work requirements don’t work

ff-Medicaid-Spending [1]A new report from the Washington, DC-based Center on Budget and Policy Priorities [2] shows why imposing work requirements on people who receive Medicaid would increase the number of poor people who are uninsured. The health care plan that House Republican leaders introduced in June would allow states to impose such requirements on Medicaid beneficiaries and North Carolina officials have expressed a desire to do so as well.

The main effect of a Medicaid work requirement likely would be the loss of health coverage for substantial numbers of people who are unable to work or face major barriers to finding and retaining employment.

Moreover, the research indicates that a work requirement would produce such a result with little or no long-term gain in employment. In fact, if the resulting loss of coverage led to a deterioration in health for some people, as it well could, a work requirement could make it harder for some of the affected poor adults to work.

This is from the introduction to the report:

The health care plan that House Republican leaders introduced in June would restructure federal funding for state Medicaid programs by capping per-beneficiary funding or converting the program to a block grant (states would have to choose one), which would lead to cuts in eligibility and benefits that would grow larger over time.[1] [3]  On top of these far-reaching changes to Medicaid’s structure, the plan also would allow states to impose work requirements on Medicaid beneficiaries, which likely would further increase the number of poor people who are uninsured.

Medicaid enables low-income individuals and families to obtain health care coverage.  For some people, Medicaid provides short-term coverage during pregnancy or tough economic times.  For many seniors and people with disabilities, it provides long-term services and supports that allow them to stay in their homes.  Most Medicaid beneficiaries who can work do so.

The experience of the Temporary Assistance for Needy Families (TANF) program indicates that imposing a work requirement on Medicaid would likely be counter-productive.  Its main effect likely would be the loss of health coverage for substantial numbers of people who are unable to work or face major barriers to finding and retaining employment.  A work requirement could make it harder for some of the affected poor adults to work. Moreover, the research indicates that a work requirement would produce such a result with little or no long-term gain in employment.  In fact, if the resulting loss of coverage led to a deterioration in health for some people, as it well could, a work requirement could make it harder for some of the affected poor adults to work.

Furthermore, the proposal to authorize states to impose work requirements in Medicaid apparently comes with no added resources for job training or other employment services, subsidized job positions, child care assistance, or other work supports to help beneficiaries prepare for work or raise their earnings.  State Medicaid agencies, whose resources would be stretched just to cover the basic costs of administering and enforcing work requirements, are very unlikely to be able to provide the needed job training, work supports, additional child care, and the like within existing resources.

Among the individuals who would be subject to such a work requirement are newly covered low-income adults in states that have expanded Medicaid under health reform.  As explained below, a work requirement likely would undercut some of health reform’s coverage gains.

Click here to read the entire report. [2]