On April 5, the Senate passed an amended fiscal 2025 budget revolution that maintained proposed cuts to Medicaid, including the introduction of work requirements.
Here are 10 things to know about the work requirements and what they mean for physicians:
1. The work requirements proposal, introduced by Sens. John Kennedy, R-La., and Eric Schmitt, R-Mo., would require able-bodied adults without dependents to work or volunteer at least 20 hours a week to receive benefits.
2. Work requirements could save $109 billion over 10 years, according to a Congressional Budget Office analysis published in 2023. That year, House Republicans included work requirements in a bill to raise the debt ceiling. The requirements were later struck from the bill.
3. However, an analysis published March 17 by the Urban Institute by the Urban Institute and the Robert Wood Johnson Foundation warns that up to 5 million adults could lose their Medicaid coverage by 2026 — not because they fail to meet work criteria, but due to bureaucratic hurdles and reporting challenges.
4. “Work requirements are a blunt tool that creates costly administrative red tape and separates eligible people from health coverage they rightfully qualify for,” Katherine Hempstead, senior policy adviser at the foundation, said in a news release. “Nearly all adults who gained coverage through Medicaid expansion already meet work requirements. People would not lose healthcare coverage because they are ineligible. They would lose coverage because of the bureaucratic burden the program would put on people across the country.”
5. Researchers project that between 4.6 million and 5.2 million adults will lose Medicaid in 2026 if Congress enacts work requirements for Medicaid expansion enrollees.
“Even if work requirements are limited to expansion, adults and states use available data to try to automatically identify those who are exempt or compliant, millions of Medicaid enrollees would lose coverage,” Michael Karpman, principal research associate at the Urban Institute, said. “Most of these adults would become uninsured and lose access to essential healthcare, including substance use disorder and mental health treatment, medications needed to manage chronic health conditions and treatment for life-threatening illnesses such as cancer.”
6. According to researchers, more than nine in 10 adults with Medicaid expansion coverage:
- Work some or all months of the year;
- Are parents or caregivers for dependent children under 18;
- Attend school;
- Care for a disabled household member;
- Are in fair or poor health or have a functional limitation;
- Are looking for a job;
Other adults may be pregnant, have physical or behavioral health conditions, care for someone outside their household, participate in job training or community service, or possess other unobservable attributes in the Urban Institute’s data that could exempt them from work requirements.
7. Historical data from Arkansas and New Hampshire, which briefly implemented work requirements, shows that 72% to 82% of enrollees lost coverage due to reporting issues, not failure to meet work criteria, according to researchers. Confusion, lack of awareness and reporting difficulties — not ineligibility — were the primary reasons for Medicaid disenrollment in these states.
8. States’ ability to mitigate coverage loss depends on their exemption processes, but not all states may implement strong data-matching systems to automatically verify compliance, according to the report.
9. Many affected individuals would become uninsured, according to the researchers, increasing the burden on hospitals through uncompensated care costs. Hospitals, especially those in rural and underserved areas, could see higher emergency room visits and increased demand for charity care.
10. Patients with chronic conditions, such as diabetes, heart disease or behavioral health disorders, could experience worsened health outcomes due to interrupted care and medication access.
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