For the first time, the federal government is allowing states to require people to work or volunteer in order to have Medicaid benefits.
Ten states have already filed applications to implement the work requirement. Below we explore several questions about this. First, what constitutes work per the requirements? Second, how much of an impact on people will these waivers have? And last, if Texas sought the work requirement provision, how might it impact the state’s Medicaid customers?
On January 11, 2018, the Centers for Medicare and Medicaid Services Administrator Seema Verma tweeted that work requirement waivers would “improve Medicaid enrollee health outcomes by incentivizing community engagement.”
Community engagement is flexibly defined and can include work, care giving, volunteering, and drug and substance abuse treatment.
According to the rules, “people who are elderly or disabled and pregnant women and children would be excluded.”
To begin to understand impact, we look to research about work in the Medicaid population. Kaiser Family Foundation research shows that most non-elderly, non-SSI Medicaid adults work (Figure 1).
Overall, the Kaiser Family Foundation found that approximately 60% of non-disabled, working-age adults already have jobs, while nearly 80% are part of families with at least one member in the labor force.”
Kaiser found that Medicaid beneficiaries who are not working most commonly cite illness as the reason why (Figure 3). Experts share that “people can have physical or mental health problems -- such as arthritis or asthma -- that don't meet the criteria for federal disability programs, but still interfere with their ability to work.”
The second most common reason people give is family care or home obligations (some types of caregiving would exempt Medicaid beneficiaries from waiver requirements).
If Texas were to pursue this waiver, experts do not foresee it having a large impact on Texas Medicaid customers. This is because states can structure Medicaid eligibility, resulting in some states’ Medicaid programs including certain populations and other states’ programs excluding the same group. Texas Medicaid is structured such that the majority of beneficiaries are children, pregnant women, and disabled individuals, all of whom would be exempted from Medicaid work requirements per the new
rules. Therefore, it is anticipated that the impact of a Medicaid work requirement waiver would be minimal if implemented in Texas.