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Study Finds Work Requirements Likely Hurt Chronically Ill

Photo by Heidi de Marco/KHN

A new study published in Health Affairs suggests that states that have enacted Medicaid work requirements for adults are making it more difficult for those with chronic health conditions to retain coverage, which in turn makes it more difficult for them to work, according to Reuters.

The study, which examined data between 2014 and 2016 from the National Survey on Drug Use, found that individuals with serious mental illness or substance abuse, or both, were more likely to have worked less than 20 hours in the previous week. Working 20 hours in a week is the typical requirement for states with the rules.

As of February 2019, six states had work requirements approved, eight states were awaiting approval, and one was facing a legal challenge. Supporters of Medicaid work requirements argue that employment will help move vulnerable individuals out of poverty. Opponents argue the opposite, that taking coverage away from those individuals makes it more difficult for them to hold employment.

The study’s co-author Brendan Saloner, of John Hopkins Bloomberg School of Public Health, says that Medicaid recipients have more physical and mental health issues than the general population.

“What our study adds is new information showing that among the Medicaid population that is likely to be subject to work requirements, there is likely to be greater burden on those with physical and behavioral health conditions,” Saloner said by email.

“It underscores that any attempt to implement work requirements will need to confront the reality that many of the people who are likely to risk losing their coverage have significant health needs that likely prevent them from working,” Saloner added.

While nearly half of Medicaid enrollees without any recorded health issues met the work requirements, the study found that only 23 percent of those with mental illnesses, 43 percent of those with substance abuse, and 32 percent of those with both did so.

Work requirements may be unreasonable for a significant percentage of Medicaid enrollees, many of whom suffer from debilitating health conditions, said Dr. Kumar Dharmarajan, chief scientific officer at Clover Health and an assistant professor at Yale School of Medicine in New Haven, Connecticut.

“States need to create and implement standardized criteria to identify these individuals and exclude them from work requirements,” Dharmarajan said by email. “Not doing so may result in loss of Medicaid coverage, compromised health care access, and unnecessary suffering.


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