Funded on June 1, 2020

In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued policy guidance for states interested in requiring workforce participation or other community engagement activities as a condition for Medicaid eligibility among working aged beneficiaries. 

To date, these policies have received mixed reviews: proponents say that these requirements promote financial independence for families and individuals, while opponents argue that requirements disenfranchise the nation’s most medically vulnerable citizens. 

While analyses to evaluate the potential impact of these requirements are ongoing, there has been little inquiry into the impact of these policies on low-income adults ages 51-64. These adults are more likely to have significant chronic disease burden that impacts their ability to find and maintain work. Additionally, work requirements are likely to disproportionately impact subgroups with existing disparities in health-related outcomes, including racial and ethnic minorities. 

To evaluate the potential impact of Medicaid work requirement policies on older Americans, the research team will:

  1. Characterize the health history (e.g., total number of chronic conditions, use of disease-related medications, self-reported health status), employment history, and resource access of adults aged 51-64 potentially impacted by Medicaid work requirements.
  2. Simulate the potential insurance coverage losses that could result from the implementation of Medicaid work requirements on a national scale among older adults ages 51-64 under several scenarios.
  3. Describe the impact of Medicaid work requirements on subgroups that typically have disparities in health-related outcomes, including those who are less educated, racial minorities, non-English speakers, and those living in rural areas.

Policy analysts have already begun to evaluate the potential impact of Medicaid work requirements on low-income adults, but more needs to be done to examine the impact on older Medicaid enrollees. These individuals may face significant barriers in obtaining employment, including age discrimination and age-related chronic disease burden. This work will help to characterize this important segment of the population.