Funded on October 15, 2018

In January 2018, the Center for Medicare & Medicaid Services issued guidelines encouraging states to submit Section 1115 waiver proposals requiring low-income adults to work as a condition of eligibility for Medicaid. On June 1, Arkansas became the first state to implement work requirements, sending out notices to nearly 100,000 enrollees informing them that its “community engagement” reporting requirements were now in effect. Three other states (Kentucky, Indiana, New Hampshire) have had similar Medicaid waivers approved.

While multiple studies show a positive association between employment status and improved physical and mental health, it is unclear whether this relationship is causal. Building on a rich baseline of survey work conducted in Kentucky and Louisiana, (traditional Medicaid expansion); Arkansas (expansion via private insurance); and Texas (no expansion); the research team will analyze the effects of Medicaid work requirements on coverage rates, access to care, and employment among low-income adults. They will also examine low-income adults’ perceptions and experiences with these new program requirements.

Given the growing interest in work requirements, this study has the potential to answer several key policy questions: Do these requirements increase employment among low-income adults? Do they lead to a loss of coverage among adults who can’t meet the requirements? Do they produce confusion or dissuade others from applying for Medicaid, even among some who are already working or exempt from the new rules? This study will provide timely data on the nation’s first experiences with work requirements in Medicaid.

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Related Evidence

  • Published September 8, 2020

    Arkansas implemented Medicaid work requirements in June of 2018. To maintain coverage in the state, adults ages 30-49 were required to work 20 hours a week, participate in “community engagement” activities, or qualify for an exemption. By April 2019, when a federal judge halted the policy, more than 18,000 adults had lost coverage. As an update to research published in 2018, Benjamin D. Sommers, Lucy Chen, Robert J. Blendon, E. John Orav, and Arnold M. Epstein analyzed the policy effects before, during, and after implementation in this Health Affairs brief.

    View Evidence

  • Published June 19, 2019

    In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Benjamin D. Sommers, Anna L. Goldman, Robert J. Blendon, E. John Orav, and Arnold M. Epstein of Harvard University provide the first independent assessment of early changes in beneficiary coverage and employment after the work requirements went into effect.

    View Evidence

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