Health Reform WK-EDGE Medicaid programs with work requirements not prepared to help beneficiaries find employment
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Tuesday, November 13, 2018

Medicaid programs with work requirements not prepared to help beneficiaries find employment

By Kayla R. Bryant, J.D.

Medicaid work requirement programs fail to offer sufficient social supports to enable beneficiaries to find work, such as training, help with job searching, and assistance in solving transportation needs. According to an analysis conducted by The Commonwealth Fund (CWF), more people will be subject to Medicaid work requirements than those who are subject to similar requirements under the Supplemental Nutrition Assistance Program (SNAP), and the limited resources of employment support programs for those receiving SNAP and Temporary Assistance for Needy Families (TANF) will be under additional strain when the needs of Medicaid beneficiaries are added.

Work requirements. CMS has approved Medicaid work requirements as Section 1115 demonstration projects for a handful of states, and other proposals have been submitted or are in the planning phase. Although Medicaid funding cannot be used for job training or related support services, CMS recommended that Medicaid programs join with existing work requirement programs like TANF and SNAP. Currently, TANF parents must engage in work activities, and able-bodied SNAP recipients between the ages of 18 and 49 without dependents must conduct "work activities" for 20 hours per week to avoid benefit limitations.

The CWF’s comparison noted that adding a work requirement to Medicaid greatly expands the population subject to this type of requirement, considering the larger size of the Medicaid program, the expanded age range, and inclusion of adults with children. An analysis of adults potentially subject to Medicaid and/or SNAP work requirements in the states of Arkansas, Indiana, Kentucky, and New Hampshire revealed that about 1.5 million could be under Medicaid requirements, but not SNAP, while 239,000 would be subject to SNAP requirements but not Medicaid. The number subject to requirements under both programs was 273,000.

Necessity and usefulness. The CWF ultimately concluded that Medicaid work requirement programs are not designed to improve health outcomes or increase employment, and that these programs are likely to lead to a loss of coverage. The CWF noted that CMS supported its justification for mandatory work requirements by citing a lack of involvement in Indiana’s voluntary Gateway to Work program, but the report presented the success of Montana’s program as a contrast. Montana’s HELP-Link program, designed for newly eligible Medicaid beneficiaries and incorporated into the enrollment process, resulted in 22,000 out of 94,000 new enrollees receiving job services from the state in the first six months of the program. One-on-one training services were provided to 2,500 individuals, and 91 percent of those who completed training found employment.

The CWF believed that program design is the key to helping Medicaid beneficiaries find work. Montana’s program included assessment of employment status and barriers to work during the Medicaid enrollment process, with staff reaching out to selected beneficiaries to offer personalized assessment and assistance with developing an employment plan. By contrast, CMS does not require that Medicaid programs imposing work requirements under a demonstration to notify beneficiaries of work services or to focus those services on beneficiaries most likely to benefit from them. The CWF also doubted that work requirements alone would motivate beneficiaries to seek work if they were not already doing so.

Companies: The Commonwealth Fund

IndustryNews: NewsStory NewsFeed AgencyNews DemonstrationProjectNews GeneralNews MedicaidNews

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