Trump’s Medicaid work rules dodged by 1 million

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.

Exemption Based on Unemployment Rate

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 the Exemption

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.

Number of People Exempted

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 Threshold

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.

States with High Unemployment

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.

Other Exemptions

The unemployment rate exemption is one of several carve-outs from the Medicaid work requirement in the GOP’s law. The law also exempts parents with children under 14, people who are disabled or frail, and those who are pregnant, incarcerated, or in a substance use disorder program, among others. The high unemployment provision is different than most because it exempts people living in entire counties.

Application for Exemption

To qualify for the Medicaid exemption, states would have to apply to the federal government on behalf of individuals in eligible counties. And if a county earned an exemption, the government would determine how long it applies.

Concerns and Criticisms

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.

Conclusion

In conclusion, the Medicaid work requirement exemption based on unemployment rate could provide a reprieve to millions of Americans who are struggling to find a job. However, the impact of the exemption depends on how the Trump administration interprets the law and whether states apply for the exemption. Health advocates are concerned that some states may not apply for the exemption, which could lead to more people losing their health coverage.

FAQs

1. What is the Medicaid work requirement?
   The Medicaid work requirement is a federal law that requires many adult, nondisabled Medicaid enrollees to work or volunteer 80 hours a month or go to school.
2. What is the exemption based on unemployment rate?
   The exemption based on unemployment rate allows Medicaid enrollees in counties with high unemployment to be shielded from the work requirement.
3. How many people could be exempted from the work requirement?
   According to KFF, about 4.6 million Medicaid enrollees in 386 counties could qualify for an exemption today based on the latest unemployment data.
4. What is the stricter threshold for exemption?
   The stricter threshold for exemption is based on average unemployment over a 12-month period, which would align with work requirements under the federal Supplemental Nutrition Assistance Program.
5. Which states have the most Medicaid enrollees who could be exempted based on high unemployment?
   According to KFF, about 90% of Medicaid enrollees who could be exempted based on high unemployment reside in five states: California, New York, Michigan, Kentucky, and Ohio.