How Medicaid Work Requirements Will Harm Older Americans

(Photo: Stígur Már Karlsson / Heimsmyndir)(Photo: Stígur Már Karlsson / Heimsmyndir)

More than 8.5 million Americans age 50-64 get health coverage through Medicaid. Many of them became eligible due to the Affordable Care Act’s (ACA) expansion of Medicaid to more low-income adults, which helped drive a nearly 40 percent decline in uninsured rates for lower-income people age 50-64 between 2013 and 2016.

But Medicaid coverage for many low-income, older Americans is at risk due to the Trump Administration’s decision to let states impose work requirements on enrollees, other than those who are 65 or older, pregnant, or qualify for Medicaid because they are receiving disability benefits through the Supplemental Security Income (SSI) program. The Administration has already approved work requirements in Kentucky and Indiana, and proposals from other states are pending. Approved and pending state policies generally require enrollees to provide documents showing that they worked, searched for a job, or volunteered a sufficient number of hours each month.

Older adults face particular challenges in meeting such requirements, and the health consequences if they lose Medicaid coverage are likely to be especially severe.

Older Adults Face Obstacles to Meeting Work Requirements

Across age groups, about 60 percent of non-elderly adult Medicaid enrollees not receiving SSI work; of the rest, about half live in working families, and more than 80 percent report that they are in school or unable to work due to illness, disability, or caregiving responsibilities. But employment rates are lower at older ages. Whereas nearly two-thirds of enrollees under age 50 work, work rates begin to fall off for those over 50, and only a minority of 60- to 64-year-olds work. (See chart.) In addition, some working enrollees (of all ages) work part-time, meaning they may not meet monthly hours requirements under work requirement policies.

There are many reasons older enrollees are more likely to be out of work. Some, especially those in their 60s, are…

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