Personal Responsibility and Medicaid Work Requirements: Where do we go from here?

As of 2018, 32 states and Washington DC had expanded Medicaid under the ACA, with Virginia’s expansion beginning in 2019. After the 2018 midterm elections, several additional states will likely be expanding Medicaid due to ballot initiatives or the election of a new governors. Meanwhile, five states have had 1115 waiver proposals approved allowing them to impose personal responsibility or work requirements and at least 10 more states, including Virginia, have proposed such requirements or plan to do so. In the 5 states that have approved waivers, typical requirements call for existing Medicaid beneficiaries who are not disabled or elderly to work 80 hours per month, volunteer in their community, engage in job training, or spend time on other qualifying “community engagement” activities. If such requirements are not fulfilled, Medicaid recipients will lose coverage. Arkansas became the first state to implement this program, and Kentucky – after a legal setback – is now planning to resume its work requirements in early 2019. Thus far, early evidence from Arkansas shows that more than 10,000 people have not met the reporting requirements of the program and thus have lost their Medicaid coverage. Despite all this recent activity, little is known about the impacts of these new requirements on outcomes including employment, access to care, health, and costs. In this roundtable session, presenters will discuss several questions and engage the audience in comments and discussion. Such questions will include: (1) What is already known from prior research about the effects of Medicaid on employment, and vice versa? (2) What are the different state approaches to responsibility requirements? (3) What are the most important outcomes and measures of those outcomes to track? (4) What are the important methodological challenges that arise in evaluating these programs, and how can these challenges best be addressed? (5) What data can be used and/or what data needs to be collected? The panel will include 4 participants who have worked in health and labor economics applied to Medicaid and work requirements. They include: Tom DeLeire, who has advised the U.S. Department of Health and Human Services and published multiple studies on the impact of health insurance on labor supply and access to care; Jenny Kenny, a health economist with expertise in policy analysis and program evaluation who has been analyzing proposed work requirements in Arkansas and Kentucky; Kosali Simon, who has published widely on Medicaid expansion and employment effects of the ACA and Ben Sommers, who has conducted numerous studies on the impact of the ACA’s Medicaid expansion and is now leading a survey-based project evaluating work requirements in Arkansas.The moderator, Deborah Freund, has done extensive research on the economics of Medicaid Managed Care.