Introduction to Medicaid Work Requirements
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 Struggle to Find Employment
Wunderlin’s experience is rare. Medicaid typically does not offer such help, and when states do try to help, such efforts are limited. 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.
Existing Efforts to Help Medicaid Recipients
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. Nearly two-thirds of Medicaid enrollees work, with most of the rest acting as caregivers, going to school, or unable to hold a job due to disability or illness, according to KFF, a health information nonprofit that includes KFF Health News.
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 Importance of a Supportive Approach
They argue work requirements alone are not enough. “The move to economic mobility requires a ladder, not a stick,” said Farah Khan, a fellow with the Brookings Institution, a nonpartisan think tank. While Medicaid work requirements have been debated for decades, the issue has become more heated as 40 states and Washington, D.C., have expanded Medicaid eligibility under the Affordable Care Act to the vast majority of low-income adults.
Limited Success of Work Requirements
Only Georgia and Arkansas have implemented mandates that some Medicaid enrollees work, volunteer, go to school, or enroll in job training. But a study Sommers co-authored showed no evidence work requirements in Arkansas’ program led to more people working, in part because most of those who could work already were. In Arkansas, more than 18,000 people lost coverage under the state’s requirement before the policy was suspended by a federal judge in 2019 after less than a year.
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.
Successful Programs
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 some Medicaid recipients have found success with job training programs, the overall effectiveness of these programs is limited. More attention should be paid to investments that have helped people find better jobs, rather than simply implementing work requirements. By providing a supportive approach and investing in programs that help Medicaid recipients find employment, states can help individuals like Eric Wunderlin achieve financial stability and improve their overall well-being.
FAQs
Q: What is the current state of Medicaid work requirements?
A: Currently, only Georgia and Arkansas have implemented mandates that some Medicaid enrollees work, volunteer, go to school, or enroll in job training.
Q: What is the effectiveness of Medicaid job training programs?
A: The effectiveness of these programs is limited, with most Medicaid enrollees already working, but not in jobs with health benefits.
Q: What is the approach recommended by policy experts and state officials?
A: They recommend a supportive approach, investing in programs that help Medicaid recipients find better jobs, rather than simply implementing work requirements.
Q: What is the goal of Medicaid work requirements?
A: The goal is to encourage Medicaid enrollees to find employment and ultimately reduce their need for public assistance.
Q: What are some successful programs that have helped Medicaid recipients find employment?
A: Programs such as CareSource’s JobConnect program and the University of Pittsburgh Medical Center’s Pathways to Work program have shown success in helping Medicaid recipients find employment.
By Sam Whitehead, Phil Galewitz and Katheryn Houghton, KFF Health News
