![]() These services can support work for individuals with disabilities who choose to work by addressing physical, mental health, or cognitive needs that create barriers to employment. 11 HCBS help individuals with disabilities with self-care and household activities to enable them to live independently in the community. ![]() The median income limit for this pathway is 250% FPL, well above the income limit for other coverage groups. 10 Under Medicaid buy-in programs, states can elect to cover people with disabilities who choose to work, supporting their participation in the workforce without carrying the risk of coverage loss. Medicaid also supports work by providing eligibility pathways for individuals with disabilities and home and community-based services (HCBS) that support employment and target barriers to work. 8 A study of Montana’s Medicaid expansion, including the state’s voluntary Medicaid work support program (HELP-Link), found an increase of four to six percentage points in labor force participation among low-income, non-disabled adults ages 18-64 following expansion, compared to higher-income non-Medicaid Montanans and to the same population in other states. ![]() For example, in studies on the effects of Medicaid expansion in Ohio and Michigan before CMS approved work requirements in these states, previously unemployed individuals reported that Medicaid enrollment made it easier for them to seek employment, while employed individuals reported that enrollment allowed them to perform better at work or made it easier to continue working. Research has shown that access to affordable health insurance and care promotes individuals’ ability to obtain and maintain employment. Medicaid supports employment by providing affordable health coverage, which helps low-wage workers get care that enables them to remain healthy enough to work. How can Medicaid support employment without a waiver? 7 Arkansas’s waiver that authorizes its work requirement was set aside by a federal court in March 2019, suspending the requirement’s implementation an appeal is currently pending. ![]() While the state did not track whether enrollees began work activities in response to the requirement, an independent study found no significant change in employment in response to implementation of the requirement. By February 2019, only 11% of those enrollees had regained coverage in Medicaid. The work requirement phased in beginning in June 2018, and state data revealed that, by December 2018, over 18,000 Medicaid enrollees had been disenrolled 6 from the program for failure to comply with the new requirements, with most of this coverage loss resulting from failure to report activities. The experience of Arkansas, the first state to implement a Medicaid work requirement, reveals widespread coverage losses and little measurable increase in employment as a result of the requirement. The January 2018 CMS guidance notes the importance of employment supports while stating that such support services are not eligible for federal Medicaid funds. 5 The waivers seek to promote work by making individuals’ health coverage contingent on meeting certain requirements – like reporting minimum monthly work hours – versus supporting employment through voluntary efforts that focus on identifying barriers to work and facilitating links to services that address those barriers. 4 The administration says that such policies are designed to address health determinants, such as employment, to improve health outcomes. Only about four in ten working Medicaid adults have access to employer-sponsored insurance.ĬMS issued guidance in January 2018 3 for state Medicaid waiver proposals that condition Medicaid eligibility on work and reporting requirements, and several states have received approval for or are pursuing these waivers. These enrollees may be eligible for Medicaid in expansion states if they are working low-wage jobs, while those working in non-expansion states could earn enough to become ineligible for Medicaid but not enough to qualify for Marketplace subsidies (which require income of 100% to 400% of the poverty level), while also not necessarily receiving health coverage through their jobs. Among Medicaid adults who are working, the majority (53%) work full-time for the entire year. 2 Caregiving responsibilities, illness or disability, and school attendance are the most common reasons that Medicaid enrollees report for not working, while those in better health and with more education are more likely to be working. KFF analysis shows that 63% of Medicaid adults 1 are already working, many in jobs that do not offer health insurance, and that those who are not working often face barriers to employment.
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