Medicaid Work Requirements: States’ Actions, and Inaction, Are Putting People’s Coverage at Risk
“With thousands in Arkansas losing their Medicaid benefits under the state’s work-requirement demonstration, the importance of evaluating such experiments could not be clearer,” says George Washington University’s Sara Rosenbaum and colleagues in a new Commonwealth Fund issue brief.
The nation’s first-ever Medicaid work demonstration is proceeding even though there is no approved evaluation under way to test the requirements’ impact on the people affected, as called for under Section 1115 of the Social Security Act. Rosenbaum’s team finds that, across the country, states’ evaluation designs for 1115 demonstrations that restrict Medicaid eligibility and coverage “either are lacking or contain flaws that limit their policy utility.” Meanwhile, the federal Centers for Medicare and Medicaid Services has yet to issue any evaluation guidance to states.
Without robust evaluation, Rosenbaum says, the core purpose of Section 1115 — to permit demonstrations that promote Medicaid’s objective of insuring people with low incomes — is lost.
On To the Point, Rosenbaum and team report that rather than simplify the Medicaid enrollment process, as the Affordable Care Act sought to do, the Trump administration and some states are making it more complicated. In addition to work mandates, some states seek to compel enrollees to report their eligibility status on a weekly basis. Others propose to charge premiums, implement lockout periods for people who are unable to comply with the new requirements, or return to cumbersome paper verification requirements and asset tests.
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