Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements


Medicaid work requirements remain a key policy of interest, with waiver approvals of such requirements before the Supreme Court and the Biden Administration likely to reverse this Trump Administration policy. Additionally, the coronavirus pandemic and economic downturn have health and economic implications for working and non-working Medicaid adults. To provide context to the current landscape of Medicaid and work, this brief explores work status and characteristics of Medicaid enrollees as well as perspectives from enrollees who participated in focus groups in three cities (Cleveland, Detroit, and Milwaukee) prior to the pandemic. Key findings include the following:

  • Prior to the pandemic, most Medicaid adults who did not face a barrier to work were working. Adults who work full-time may still be eligible for Medicaid in expansion states because they work low-wage jobs and still meet income eligibility criteria, but those in non-expansion states are less likely to be eligible.
  • Many Medicaid adults who were working or faced challenges to work were likely affected by COVID-related job or income loss. The pandemic has likely exacerbated existing challenges to work reported by Medicaid enrollees. Those who were not working before the pandemic are unlikely to have moved into employment during the downturn, particularly because many face barriers to work such as functional disability. As a result of job loss or reduced hours, many workers may have had their income or financial security worsened by the pandemic.
  • People who remain eligible could lose Medicaid coverage as a result of work and reporting requirements. Loss of coverage could have negative implications for a person’s ability to work and can also increase uncompensated care for providers. Medicaid enrollees face an array of barriers to complying with work and reporting requirements. In addition, research finds that work requirements may not result in increased employment or employer-based health coverage.

Looking ahead, key issues to watch include the continued effects of the pandemic and economic downturn on Medicaid and work, policy actions under the Biden Administration around work requirements, and the Supreme Court case.

Issue Brief

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