Ohio’s Medicaid work requirements are back from the dead

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With a new administration in Washington, state policymakers are reviving their zombie policy of Medicaid work requirements.

Work requirements have been a bit of a political football over the past couple of administrations. While food and income went from being a right for all to a right for all who work during the welfare reform era of the 1990s, health insurance managed to dodge that bullet. During the Obama Administration, however, congressmen and state leaders began kicking around the idea of making health insurance subject to a requirement to work, especially for a newly-covered category of low-income adults without children.

This policy became a reality in states across the country in 2018 as the Trump Administration began issuing waivers to states looking to impose work requirements on Medicaid recipients. A total of 13 states including Ohio were granted waivers and authority to revoke health insurance from low-income adults without children who could not prove they met requirements for paid work hours.

Judges started striking these requirements down soon after they were imposed before the Biden Administration rescinded and withdrew the waivers that allowed them. With the incoming Trump administration, though, supporters of Medicaid work requirements are bullish on the opportunity to reimpose requirements on health insurance recipients.

The imposition of work requirements during the Trump administration gave us a perspective on what the impact of these work requirements were on Medicaid recipients. If work requirements are reimposed, we can expect people to lose their health insurance and for it to threaten their economic security.

According to the Congressional Budget Office, the state experiments of the Trump Administration showed tepid results. Many people lost health insurance coverage under the requirements and there was little evidence that people worked more because of them.

Arkansas was the only state that kept the requirements in place for more than a few months, with their requirement in place for almost a year before being struck down by a federal judge. Over that time period, about a quarter of people subject to the requirement lost their Medicaid coverage.

Researchers studied the employment impact of Arkansas’s work requirements through surveys of people subject to it. One statistical approach found a small increase in employment, but not enough to be considered statistically significant. The other found a small decrease in employment among people subject to the requirements.

The study suggested work requirements also made households less stable. The researchers said the proportion of adults subject to the requirement with serious problems paying their medical bills doubled after institution of the requirements.

Why did enrollment go down and employment not budge under the Arkansas work requirement? It seems that much of the problem was administrative. A third of people subject to the requirement reported they were not aware of the new requirement. Analysis by the Kaiser Family Foundation suggests reporting requirements was the primary driver of failure to meet requirements: many people who lost coverage were working enough to qualify but administrative red tape pushed them off the program.

Medicaid is not cheap, but it is a powerful tool for creating financial stability in low-income households. For the 780,000 low-income Ohioans who may be subject to these work requirements, this extra red tape could be the difference between financial stability and crippling medical debt.

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