Up to 1 million low income and disabled people across the Midwest could lose their Medicaid health insurance coverage, according to a new analysis. That’s because federal lawmakers are considering adding Medicaid work requirements, which means people would have to prove they work, volunteer, or go to school in order to receive health insurance.
Experts warn that many people who already work will fall through the cracks — not because they are ineligible for benefits but due to administrative and paperwork mishaps.
The latest version of the House Republicans’ tax and immigration bill, which proposes deep cuts to federal programs like Medicaid, includes strict work requirements, even expanding those requirements to Americans previously considered too old to need them.
Under the bill, Medicaid recipients 19-64 years of age, with some exceptions, will need to complete 80 hours of work per month, do community service, or be partially enrolled in an education program. Previous proposals have exempted Americans older than 55 from the requirements.
An analysis done by the Urban Institute and Robert Wood Johnson Foundation used data from states with existing work requirements, like New Hampshire and Arkansas, to estimate how the proposed federal changes might impact states.
Katherine Hempstead, who worked on the analysis, said they found that in these states many people who meet the requirements still end up being kicked off of the programs, often because they fail to complete the necessary paperwork.
“We estimate that roughly two-thirds of those people that lose coverage actually shouldn't lose their coverage,” she said, adding that they lose it due to “compliance problems, not because they truly are not eligible.”
The analysis looked at how adding the 55-64 age group into the mix increased the number of people expected to lose coverage. In the Midwest, roughly 200,000 more people would lose their Medicaid coverage under the requirements than if they only applied to 19-55 year olds.
Several states, including Indiana, have also been in the process of passing work requirements of their own.
During the most recent session, Indiana lawmakers instituted work requirements that look similar to the federal ones: requiring 20 hours of work a week, volunteering, or attending an educational program full time. The program similarly applies to the 19-64 age group.
Up to 137,000 low-income and disabled people in Indiana could lose their Medicaid health insurance, according to the analysis.
Experts, including Hemptstead, said it’s unclear how the proposed federal work requirements would play out with Indiana’s recent law. She expects lawmakers may just reconcile the differences between the state’s own law and the federal one.
Potential coverage losses vary by state. Up to 257,000 people could lose coverage in Illinois, 220,000 in Ohio, and 165,000 in Kentucky.
Other states, such as Nebraska, would see coverage losses of about 18,000. Iowa could see 47,000, and Oklahoma is projected to see 61,000.
The bill, which passed out of the U.S. House last week, also includes expanded work requirements for the Supplemental Nutrition Assistance Program, or SNAP.
Republicans in the Senate are hoping to pass the bill in early July, but it may ultimately not receive a vote until later in the summer.
Contact Health Reporter Benjamin Thorp at bthorp@wfyi.org.
Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.
