Introduction to Medicaid Work Rules
Millions of Medicaid enrollees may have a way out of the new federal work requirement — if they live in a county with high unemployment. By January 2027, President Donald Trump’s far-reaching domestic policy law will require many adult, nondisabled Medicaid enrollees in 42 states and Washington, D.C., to work or volunteer 80 hours a month or go to school.
Exemptions Based on Unemployment Rates
But under the law, Medicaid enrollees in counties where unemployment is at least 8% or 1.5 times the national unemployment rate could be shielded from the work requirement, if their state applies for an exemption. A new analysis by KFF shows that exemption in the GOP’s work requirement could offer a reprieve to potentially millions of Americans caught in a tough spot — needing to work to secure health insurance but having trouble finding a job.
Impact of Exemptions
The Congressional Budget Office projected the work requirement would apply to 18.5 million Medicaid enrollees, causing about 5.3 million to lose their government health coverage by 2034. CBO spokesperson Caitlin Emma confirmed to KFF Health News that analysts factored the unemployment rate exemption into their projections. Only states that expanded Medicaid under the 2010 Affordable Care Act or a special waiver must enact a work requirement, under the federal law.
Eligibility for Exemptions
For example, if Trump officials exempt people in counties where the unemployment rate has been above the law’s thresholds for any month over a 12-month period, about 4.6 million Medicaid enrollees in 386 counties could qualify for an exemption today based on the latest unemployment data, according to KFF, a health information nonprofit that includes KFF Health News. That amounts to just under a quarter of all Medicaid enrollees subject to the work requirement.
Stricter Thresholds
But, she said, the Trump administration is more likely to adopt a stricter threshold based on average unemployment over a 12-month period. That would align with work requirements under the federal Supplemental Nutrition Assistance Program, the food assistance commonly known as food stamps. Only about 1.4 million Medicaid enrollees living in 158 counties could be exempted under that standard, or about 7% of the total subject to work requirements, KFF found.
State-Level Exemptions
Based on the 12-month criteria, about 90% of Medicaid enrollees who could be exempted based on high unemployment reside in five states, according to KFF: California, New York, Michigan, Kentucky, and Ohio. California alone accounts for over half of those who could be exempted. The unemployment rate exemption is one of several carve-outs from the Medicaid work requirement in the GOP’s law.
Concerns Over Exemptions
Even if the federal government grants exemptions broadly, health advocates fear some Republican-led states could balk at applying for exemptions in order to keep enrollment down, as they say has been the case with SNAP exemptions. As of 2023, 18 states did not have an exemption under the SNAP program, even though some of their residents might be eligible. “It’s not a guarantee that people can rely on,” said Emily Beauregard, executive director of Kentucky Voices for Health, an advocacy group that intends to push for the broadest possible exemptions to help people maintain their coverage.
Criticisms of Medicaid Work Requirements
Critics point out that most Medicaid enrollees already work or have a disability or caregiving responsibilities, and they argue the reporting requirements merely serve as a bureaucratic hurdle to obtaining and keeping coverage. Under the GOP law, enrollees’ work status needs to be verified at least twice a year. Most of the coverage losses due to work requirements occur among people who work or should qualify for an exemption but nevertheless lose coverage due to red tape, research shows.
Conclusion
In conclusion, the new federal work requirement for Medicaid enrollees may have a significant impact on millions of Americans, but exemptions based on high unemployment rates could offer a reprieve for some. However, the implementation of these exemptions and the overall effectiveness of the work requirement remain uncertain.
FAQs
- Q: What is the new federal work requirement for Medicaid enrollees?
A: The new federal work requirement requires many adult, nondisabled Medicaid enrollees in 42 states and Washington, D.C., to work or volunteer 80 hours a month or go to school. - Q: How can Medicaid enrollees be exempted from the work requirement?
A: Medicaid enrollees in counties where unemployment is at least 8% or 1.5 times the national unemployment rate could be shielded from the work requirement, if their state applies for an exemption. - Q: How many Medicaid enrollees could be exempted based on high unemployment rates?
A: About 4.6 million Medicaid enrollees in 386 counties could qualify for an exemption today based on the latest unemployment data, according to KFF. - Q: What is the stricter threshold for exemptions that the Trump administration may adopt?
A: The stricter threshold is based on average unemployment over a 12-month period, which would align with work requirements under the federal Supplemental Nutrition Assistance Program.
