Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements
Appendix I: Selected Findings from Focus Groups
To look at broad issues around work among Medicaid adults as well as potential implications of work requirements, KFF conducted focus groups in January 2020 with Medicaid enrollees in three states. We conducted six focus groups representing a total of 52 Medicaid enrollees. Two groups were held in each of three sites (Cleveland, Detroit and Milwaukee) with Medicaid workers and non-workers participating in separate groups. Focus groups were conducted by KFF, working with PerryUndem Research/Communication. Additional interviews were conducted with Medicaid managed care plans, work force services, health care providers, and other individuals with insights into the Medicaid population and the issues around work to help inform the study.
Experiences of enrollees show that even prior to the pandemic, there was a high degree of instability in availability of work for Medicaid enrollees. Some enrollees described limited ability to work more due to hours available in food service or catering jobs or because some work was seasonal or already highly variable (e.g., landscaping or construction). One focus group participant noted her family owned a landscaping business and did snow removal during the winter. However, snowfall is unpredictable, so they tried to build up a reserve from summer work to survive the winter. In addition, without benefits like paid sick leave, some focus group participants said they had difficulty maintaining jobs. The FFCRA provides emergency short-term paid sick leave and longer-term paid family leave for workers affected by coronavirus; however, not all employees are eligible for these benefits leaving gaps in benefits for many who might need them.
“Family issues like my father he doesn’t work he’s older, he has health issues so like he gets sick hey, I gotta go, you know, and if the job doesn’t give me FMLA… I just can’t work here no more.” Female Worker, Ohio
“That’s why I work for Uber, I can do my own hours…that’s why I got a job like that so I wouldn’t have to deal with having to take time off or have to have a certain amount of sick time.” Male Worker, Wisconsin
“With Target hours now, they get cut through January and February so I’m like getting like nothing right now…they’ve only given me sometimes four hours a week. That was shockingly even low too for this year, because last year I was like at 40 hours. So, it was a big difference.” Female Worker, Wisconsin
Medicaid adults that are working are generally healthier than non-workers but many still have significant health issues that could put them at greater risk of serious illness or death from COVID-19. Medicaid adults workers who participated in focus groups in January 2020 were experiencing a number of chronic conditions that would place them at higher risk for serious illness if infected with coronavirus including heart disease, chronic obstructive pulmonary disease (COPD), uncontrolled asthma, diabetes, or a BMI greater than 40. Other conditions mentioned by working focus group participants included Lupus, high blood pressure, high cholesterol, asthma, mental health conditions (e.g., depression, anxiety, ADHD and substance use disorders), migraines, sleep apnea, fibromyalgia, and neuropathy. Medicaid coverage helped enrollees manage chronic conditions and supported their ability to work prior to the pandemic. Many enrollees cited need for access to medication or prescription drugs to manage chronic illnesses that would be too expensive without Medicaid. However, in light of the coronavirus pandemic, those with underlying health conditions face higher health risks if they continue to work but also face financial consequences from failure to work or job loss.
“Yeah so like when the lupus flair ups there are days when like I can’t even get out of bed because like my entire body is in pain, and like that’s like, you know, like a huge inconvenience, but like it has definitely gotten better over the past couple of years.” Male Worker, Ohio
“Well I’m a recovering addict and this year in August I’ll have 4 years clean… so I had a rough, I want to say, like from late 20s, so that got me out of like swept me off my feet for a while…but I mean thank God like my old employers like they still like hired me back like after and everything like that.” Female Worker, Ohio
“I take my medicine for my high blood pressure, so it’s, it’s leveled out, it’s taken care of, and I don’t feel like I’m going to like die from a heart attack or anything like that so, I feel great with my health.” Female Worker, Wisconsin
“I got a lot of issues…I have sleep apnea and asthma, um, high cholesterol, fibromyalgia… some random things, but I’m taking a lot of medications and stuff.” Female Worker, Wisconsin
“I mean I’ve dealt with mental health issues my entire life and still take medication for it. So, I mean it’s a constant, everyday thing, but… comes and goes, depends on the day really. I mean some days are good, some days are bad.” Male Worker, Wisconsin
“If I wouldn’t have any of the medication that I’m on. Who knows where I would be…since I was in my early 20’s diagnosed with the depression, anxiety and all that good stuff. And, without the medication it definitely is, um, more severe for me…the medication definitely keeps me more level and if I didn’t have insurance, I think each of those medications are like $100 something and that’s like way more than I can afford per month.” Male Worker, Wisconsin
“If I didn’t have it [Medicaid] I’d be dead. My insulin and diabetic supplies run about $2,000 a month by themselves. That doesn’t even include the high blood pressure and the high cholesterol stuff that I’m on. So, if I didn’t have it, I wouldn’t be here.” Male Worker, Wisconsin
Both Medicaid enrollees who were working and not working provided details about financial struggles living near or below poverty that are likely to be worse with the economic fall-out from the pandemic. Enrollees across the focus groups reported they were living paycheck to paycheck, including those who were working. Many were dealing with debt from credit cards or student loans. Costs of rent, child care, utilities, and groceries were ongoing issues but unexpected costs like car repairs added to financial stress. Many noted it was hard to “get ahead.” Even if they got a small pay increase, rent was going up faster or an unexpected expense made it difficult to move out of poverty.
“It’s just hard, you know, like I have a cellphone, but my phone doesn’t work because I can’t pay the bill for it. I’m in debt for like $160 on it at this point…it’s hard to apply for a job if they can’t reach you.” Male Non-Worker, Ohio
“My car broke down four times this month, I just got it out the shop, and yeah I don’t know when this thing is just going to completely go down. First it was the battery, then I replace the battery, then the starter went out, then once I got a new starter, the transmission line burst while I was on my way to school. And then now I just got it out the shop, but it’s just one thing after another, so like I just know that at some point, it’s gonna go and it’s not gonna come back. And then, I mean of course I got a lease termination because I’m behind on my rent.” Female Non-Worker, Ohio
“We had our lights cut off before because we were trying to juggle with the car and the rent.” Female Non-Worker, Ohio
“A lot of times like I can find a job, but $15, even at $15 an hour, once you take away Medicaid, and once you take away food stamps, then you have to pay out your pocket for your own insurance, and then you have all of your other expenses on top of that. Like it still feels like you’re just living from paycheck to paycheck, robbing Peter to pay Paul.” Female Non-Worker, Ohio
“For me like, uh, I’m doing fine, just you worry that emergency happen or you can’t work or, that’s what you worry about. As long as I’m working, I feel things is okay, but uh.” Male Worker, Wisconsin
Even prior to the pandemic when economic conditions were generally favorable, enrollees reported difficulty moving up from lower paying to higher paying and more stable jobs. Available jobs often paid low hourly wages that were not sufficient to cover living expenses. Enrollees reported feeling like they were “treading water” as they were often underemployed and stuck in low wage jobs, living pay check to pay check.
“I could get a thousand McDonald’s jobs, but that’s not going to pay my bills at the end of the month. Even if I worked a hundred hours a week it’s still not going to be enough. So, I think there are jobs but the quality of the job that you’re looking for is not always there.” Female Worker, Michigan
“…there all the 1099 work out there, where people are full time workers…but they’re a subcontractor just to make it cheaper for the employer, so that means you can’t afford benefits…” Male Worker, Michigan
“My field is pretty gig-based economy kind of stuff so it’s living contract to contract and sometimes it’s long dry spells.” Male Non-Worker, Wisconsin
“If anything, you know you’re just treading water…you’re not looking for jobs as much anymore. Right because you’re stuck in that kind of job, you don’t have the time to look for another job.” Female Non-Worker, Wisconsin