Last month, the Trump Administration released guidance opening the door for states to incorporate work requirements into Medicaid eligibility rules for adults—including parents. However, you cannot separate the fate of a child from that of her parent. By imposing work requirements, the Trump Administration is giving states a tool that could undermine the well-being of children and families.
Work requirements are harmful.
Studies show that these types of requirements are ineffective at helping individuals find or maintain employment. These rules are also unnecessary simply because most Medicaid enrollees who can work already do so. Among Medicaid enrollees who are not working, approximately 12 percent are not doing so because of caretaking responsibilities. Work requirements are unlikely to help parents find or keep a job but instead only serve as an unnecessary administrative requirement and a barrier to coverage.
Although all states that have applied for work requirements in their Medicaid programs have included an exemption for caregivers, the parameters of those exemptions vary widely, and the reality is that at least some parents are in jeopardy of losing coverage under any of the current proposals. So far, the Centers for Medicare and Medicaid Services (CMS) has approved two 1115 waivers that include work requirements: in Kentucky and in Indiana. Both states exempt certain parents from the work requirement, but each state imposes the requirement on at least some parents. In Kentucky, primary caregivers of a dependent minor child are not required to comply with the work requirement, but the exemption is limited to one caregiver per household. Indiana, on the other hand, only exempts primary caregivers of a dependent child below the age of seven. In addition, even if a state exempted all caregivers, work requirements will still likely cause some parents to lose coverage due to missed reporting deadlines and confusion about required documentation.
Losing Medicaid coverage is not only harmful to parents’ health, but also to the well-being of their children. A recent study reinforced that when parents are able to enroll in Medicaid coverage it increases enrollment among their children. Coverage for parents also has direct effects on access to services and health outcomes for kids. A report in Pediatrics found that children whose parents recently enrolled in Medicaid were 29 percent more likely to receive at least one well-child visit. Another study found that states that expanded Medicaid also saw greater declines in their infant mortality rates between 2010 and 2016, with larger declines among African American infants.