Study finds almost all who would be affected by Ky. Medicaid work rules are already meeting them, many more than in earlier study

By Melissa Patrick
Kentucky Health News

If the courts allow Kentucky to put work and community engagement requirements in its Medicaid program, only 3 percent of the program’s beneficiaries would not already be meeting them, according to interviews with them for by The Commonwealth Fund, a New York City-based foundation.

The other 97% of the Medicaid population in the study reported they were meeting the proposed requirements by either working or participating in an approved list of community engagement activities 20 hours a week, or qualifying for an exemption.

The study is based on telephone interviews with 500 low-income Kentuckians in November and December 2018, including 297 who reported having Medicaid coverage. The results differed significantly from an earlier study with different methodology.

The earlier study was based on Medicaid records as of February 2018, and a random-sample survey of 9,936 people who would be subject to the new requirements. It found a much smaller share of Kentuckians meeting Medicaid work rules that would affect them: 64%.

That study was conducted by the University of Pennsylvania, which the state and the Centers for Medicare & Medicaid Services hired to evaluate the plan if it takes effect. It was done independently under contract provision that allows the university to conduct its own research.

The latest study, for the Commonwealth Fund, asked about the proposed work or “community engagement” requirements and their current work and community-engagement activities.

It found that 44% were unable to work because of a disability; 34% were working at least 20 hours a week; 11% were spending at least 20 hours a week in school, caring for a family member or participating in community service; 8% were spending at least 20 hours a week looking for work or training for a job; and 3% would likely not satisfy the proposed requirements.

The Bevin administration argues that work requirements encourage “able-bodied” people to find work, which will ultimately improve their health. And Bevin has said that “hundreds of thousands” of able-bodied adults on Kentucky Medicaid should be working, but choose not to.

If the work and community-engagement requirements go forward, those affected by them will have to report monthly and be locked out of the program for non-compliance. Health advocates have long argued that many Kentuckians would lose their coverage because of this onerous requirement.

The Medicaid plan, called Kentucky HEALTH for Helping to Engage and Achieve Long Term Health, has been blocked twice by a federal judge in Washington, D.C.; his rulings will be considered by three appellate judges on Friday, Oct. 11.

The latest study also found that 80% of low-income Kentuckians surveyed were unsure whether the work requirement was in effect; 12% thought that it was, and only 8% knew it wasn’t. It also found that 55% of all low-income Kentuckians, and 46% of those on Medicaid, said they had heard “nothing at all” about the requirements.

The report notes that because not all Kentucky Medicaid beneficiaries will be subject to the new policy, this could have affected the rates of how many had heard about it. “This high level of confusion may have dissuaded some eligible individuals from enrolling in Medicaid,” says the report.

The study also found that 39% of Medicaid beneficiaries who self-identified as a racial minority were likely to know about the requirements, while 57% of whites were. Those with less than a high-school education had less awareness than those with some college education: 48% and 62%, respectively.

Awareness also varied by age group, with younger adults less likely to know about the policy than older adults. The study found that 41% of Medicaid beneficiaries aged 19-29 said they knew about the proposal, while 58% of those 30-64 did.

“The survey found similar results in Arkansas, which implemented work requirements in 2018 and experienced higher uninsured rates, no increase in employment, and substantial confusion,” says the report. Arkansas’ work requirements have also been struck down.

The researchers called on policymakers to consider these issues if such policies are allowed to move forward.

They concluded, “To reduce potential coverage losses, states should increase awareness of work requirements, especially among minority groups and people with lower levels of education, and reduce the administrative burden of reporting. Research to evaluate these ongoing state efforts will be essential.”