How do disability and poor health impact proposed Medicaid work requirements?

February 2018
H. Stephen Kaye
A pie chart with five colored slices of pie, divided vertically approximately in the middle.  The left half of the pie is labeled "In labor force (with or without disability)"; it has two slices, one labeled "Employed 41.2%" and the other "Looking for work 11.2%."   The right half is labeled "Not in labor force"; three slices of pie are labeled "Exempted due to disability 27.7%," "Caring for family, attending school, already in work program 14.1%," and "No identified community engagement 5.9%"

In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued guidance that would allow states to use 1115 Waivers to add “work and community engagement” requirements for working-age Medicaid beneficiaries.  This report examines the extent to which disability affects working-age Medicaid beneficiaries, and identifies the subset of beneficiaries with disabilities and work-limiting health conditions who would likely be exempt from proposed Medicaid work requirements or would benefit from modified requirements. Findings come from an analysis of 2014–16 data from the National Health Interview Survey.

Two of every five working-age Medicaid beneficiaries can be classified as having a disability. Most of these beneficiaries are limited in their ability to work and would need an exemption or modification to proposed Medicaid work requirements.  However, many of these beneficiaries are not readily identified as having disabilities, and would be at risk of losing much-needed health coverage if states were to implement work requirements without adequate safeguards.  Findings indicate that, once beneficiaries who would appropriately be exempted from work requirements are removed from consideration, along with people already participating in the labor force or engaged in other worthwhile community activities, only 6 percent of working-age Medicaid beneficiaries remain as likely targets of new work or community engagement requirements.

Last modified Feb 13, 2019