Skip to main content


Chronically Ill Patients Less Likely to Meet Medicaid Work Requirements

By Alexandra Wilson Pecci  
   April 04, 2019

For hospitals, a lack of coverage for chronically ill patients translates to more uncompensated care and bad debt.

Medicaid enrollees with behavioral health and other chronic conditions are less likely to be working part or full time than people without these conditions, finds a new Health Affairs study.

As a result, these patients are less likely to meet work requirements for Medicaid that have been implemented or proposed in some states, the researchers said.

For hospitals, a lack of coverage for chronically ill patients translates to more uncompensated care and bad debt.

A Commonwealth Fund study released earlier this month estimates that Medicaid work requirements could contribute to an increase in uncompensated care costs for hospitals across 15 states that have implemented the mandates, or hope to, totaling between $2.5 billion to $3.7 billion in 2019.

For the new Health Affairs study, researchers from the University of Kentucky, Johns Hopkins University, and Emory University used data from the National Survey on Drug Use and Health to examine whether adults with serious mental illness, substance use disorders, and/or other health conditions are more likely to be subject to Medicaid work requirements compared to adults without any identified conditions.

Among Medicaid enrollees age 18 to 64, those with serious mental illness were less than half as likely to have worked part or full time (at least 20 hours) in the past week as those without any health conditions.

That means they would be unlikely to meet work requirements.

Medicaid enrollees with substance use disorders, and enrollees with comorbid serious mental illness and substance use disorders were also less likely to have worked part time in the past week.

The authors excluded from the sample people who aren't typically subject to work requirements including pregnant women, full-time students, and those receiving Supplemental Security Income.

"If policymakers consider implementing Medicaid work requirements, it is crucial that they also take a hard look at how accessible mental health and substance use treatment are for Medicaid enrollees in their state," Janet Cummings, PhD, associate professor of health policy and management at Emory University Rollins School of Public Health and senior author of the study, said in a statement.

Medicaid work requirements have been the subject of intense legal fights.

Just last week, the same federal judge who blocked Medicaid work requirements from taking effect in Kentucky nine months ago did so again. He struck down similar requirements for Arkansas as well.

D.C. District Court Judge James E. Boasberg granted summary judgment in favor of the Medicaid beneficiaries who sued to block each state's Medicaid waiver, which the Trump administration approved as part of a push to embrace what it describes as "community engagement" requirements.

In addition to Kentucky, Arkansas, and New Hampshire, there are five other states with Medicaid waiver approvals that include work requirements: Arizona, Indiana, Michigan, Ohio, and Wisconsin. At least nine more have requests for such waivers pending.

Between 1.4 million and 4 million people could lose coverage if work requirements were imposed nationwide, according to estimates by the Kaiser Family Foundation.

Alexandra Wilson Pecci is an editor for HealthLeaders.

Get the latest on healthcare leadership in your inbox.