Report Says Many with Disabilities Aren't Protected From New State Medicaid Work Requirements

A new report suggests that many people with disabilities will unfairly lose Medicaid coverage as a result of a new requirement in some states that Medicaid recipients work for their benefits.    

For millions of people with disabilities, Medicaid is a lifeline. Even short interruptions in coverage can have long-term physical and mental health consequences, exacerbate barriers to employment, and cause financial hardship.

While work requirements—requirements that beneficiaries report on an ongoing basis their work or work-related activities—have existed for years for unemployment insurance, federal cash assistance, and other federal and state programs, no such requirement has ever existed as a precondition for receiving Medicaid, until now.

In a 10-page guidance document released to state Medicaid agencies in January 2018, the Trump Administration announced a new policy where states can petition the Department of Health and Human Services (HHS) for waivers permitting them to impose work requirements on Medicaid beneficiaries.

The guidance document specifically exempts people classified as “disabled” under federal Medicaid law, meaning they receive Social Security disability benefits or certain types of institutional care. Although HSS provided little further guidance, exemptions also apply where people are “medically frail” or have “acute medical conditions validated by a medical professional that would prevent them from complying with the requirements.”

Arkansas’ Medicaid work-requirement program, the nation’s first, went into effect at the beginning of June. HHS has also approved waivers for Kentucky, Wisconsin, Indiana, and New Hampshire.

In Arkansas, Medicaid beneficiaries must report 20 hours of work or work-related activity weekly. People who fail to report 80 hours monthly for three straight months automatically lose coverage. As a result, Arkansas’ Medicaid program dropped more than 8,400 beneficiaries in September and October 2018. Nearly one-quarter of Medicaid beneficiaries were out of compliance in September alone, according to a new report, released November 14, 2018, by the Center on Budget and Policy Priorities.  The report is titled “Medicaid Work Requirements Don’t Protect People With Disabilities.”

“It appears likely that people with disabilities who face barriers to work are among both those who have already lost coverage and those at risk of losing it,” the report states. “More Arkansans are losing Medicaid coverage than the presumed target group of people who are not working and do not qualify for an exemption.

“It’s likely that many of them are already working or should be exempt, including people with disabilities who may have particular challenges navigating the additional bureaucracy to claim an exemption or report their work activities.”  

The report criticizes the state for failing to implement any kind of screening program to ensure that exempt beneficiaries are not subjected to the work requirements. It also argues that the notices violate basic due process rights by being ambiguous and failing to inform people with disabilities of their rights under the Americans with Disabilities Act, which, among other things, permits people to request reasonable modifications of public programs.

The U.S. District Court for the District of Columbia has blocked Kentucky’s program from going into effect, finding that HHS did not consider how the work requirements “would help the state furnish medical assistance to its citizens, a central objective of Medicaid." Rather than appealing the decision, HHS opened a new public comment process and approved a new waiver for Kentucky on November 20.

To read the Center on Budget and Policy Priorities' report, click here.

Click here for a PBS video segment on Arkansas’ new Medicaid work requirements.