States push Medicaid work rules, but few programs help enrollees find jobs

Introduction to the Issue

By Sam Whitehead, Phil Galewitz and Katheryn Houghton, KFF Health News

For many years, Eric Wunderlin’s health issues made it hard to find stable employment. Struggling to manage depression and diabetes, Wunderlin worked part-time, minimum-wage retail jobs around Dayton, Ohio, making so little he said he sometimes had to choose between paying rent and buying food. But in 2018, his CareSource Medicaid health plan offered him help getting a job. It connected him to a life coach, who helped him find full-time work with health benefits. Now, he works for a nonprofit social service agency, a job he said has given him enough financial stability to plan a European vacation next year.

The Push for Work Requirements

Republicans in Congress and several states, including Ohio, Iowa, and Montana, are pushing to implement work requirements for nondisabled adults, arguing a mandate would encourage enrollees to find jobs. And for Republicans pushing to require Medicaid enrollees to work, Wunderlin’s story could be held up as evidence that government health coverage can help people find employment and, ultimately, reduce their need for public assistance. Yet his experience is rare. Medicaid typically does not offer such help, and when states do try to help, such efforts are limited.

Existing Efforts and Their Limitations

Existing efforts to help Medicaid recipients get a job have seen limited success because there’s not a lot of “room to move the needle,” said Ben Sommers, a professor of health care economics at the Harvard T.H. Chan School of Public Health. Most Medicaid enrollees already work — just not in jobs with health benefits, he said. “The ongoing argument that some folks make is that there are a lot of people freeloading in Medicaid,” he said. “That’s just not supported by the evidence.”

Using Health Programs to Encourage Work

The GOP-controlled Congress could allow or require states to implement a Medicaid work requirement as part of revamping and downsizing Medicaid. The first Trump administration encouraged those work mandates, but many were struck down by federal judges who said they were illegal under federal law. Policy experts and state officials say more attention should be paid to investments that have helped people find better jobs — from personalized life coaching to, in some cases, health plans’ directly hiring enrollees.

The Hunt for Results

State officials say they don’t have much data to track the effectiveness of existing job programs offered by Medicaid plans. Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid, said the state does not track outcomes because “the health plans are not employment agencies.” Officials with CareSource, which operates Medicaid plans in multiple states, say it has about 2,300 Medicaid and ACA marketplace enrollees in its JobConnect program — about 1,400 in Ohio, 500 in Georgia, and 400 in Indiana.

Examples of Success

The program connects job seekers with a life coach who counsels them on skills such as “showing up on time, dressing the part for interviews, and selling yourself during the interview,” said Jesse Reed, CareSource’s director of life services in Ohio. Since 2023, about 800 people have found jobs through the program, according to Josh Boynton, a senior vice president at CareSource. The health plan itself has hired 29 Medicaid enrollees into customer service, pharmacy, and other positions — nearly all full-time with benefits, he said.

Conclusion

In conclusion, while there are efforts to implement work requirements for Medicaid enrollees, the effectiveness of such requirements in helping people find jobs is debated. Programs like CareSource’s JobConnect show promise, but more data and investment are needed to understand what works best in supporting Medicaid enrollees in finding employment. The focus should be on providing support and resources rather than solely on mandates, to truly help individuals achieve financial stability and improve their overall well-being.

FAQs

• Q: What is the current debate around Medicaid work requirements?
  A: The debate centers around whether requiring Medicaid enrollees to work will encourage them to find jobs and become more self-sufficient, or if it will unfairly penalize those who are unable to work due to various reasons.
• Q: How many Medicaid enrollees already work?
  A: Nearly two-thirds of Medicaid enrollees are already working, with most of the rest acting as caregivers, going to school, or unable to hold a job due to disability or illness.
• Q: What kinds of programs have been successful in helping Medicaid enrollees find jobs?
  A: Programs that offer personalized support, such as life coaching, and those that provide training and education, have shown promise in helping enrollees find better-paying jobs with health benefits.
• Q: Why are some states pushing for work requirements despite the controversy?
  A: Proponents argue that work requirements will encourage enrollees to find employment and reduce their reliance on public assistance, though critics argue that this approach may not address the underlying issues of poverty and lack of job opportunities.