Study: People with behavioral health conditions less likely to meet Medicaid work requirements

People with behavioral health conditions may struggle to meet Medicaid work requirements. (Getty/designer491)

People with behavioral health conditions are more likely to struggle to meet work requirements than other Medicaid beneficiaries, according to a new study.

Medicaid members with behavioral or other chronic health conditions were less likely to have worked 20 hours or more in a given week, thus not able to meet work requirements, according to a review of data from the National Survey on Drug Use and Health, which was published in Health Affairs. As such, this population is likely to need behavioral health services and exemptions from work requirements. 

"We had expected to see that people with mental health and substance use disorders were more likely to be enrolled in Medicaid and less likely to meet the 'year-round work.' However, we still found the numbers of those with mental health and substance use disorders who may be subject to work requirements were quite alarming," Hefei Wen, Ph.D., an assistant professor at the University of Kentucky School of Public Health and the study's lead author, told FierceHealthcare. 

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The researchers estimated that 13.2% of nonelderly adults have serious mental illness (SMI), substance use disorder (SUD) or both. 

This population was significantly more likely to be enrolled in Medicaid, with13.8% enrollment versus 8.4% enrollment among those who do not have SMI or SUD, the researchers found. In addition, Medicaid enrollees with SMI only (22.8%), those with SUD only (42.8%) and those with both SMI and SUD (32.3%), were less likely to have worked 20 hours or more in the past week. 

The report states that If work requirements are to be a continued piece of Medicaid policy, it will be crucial to ensure that Medicaid covers a full continuum of behavioral health services and that Medicaid enrollees with work-limiting conditions are given reasonable accommodations and exemptions. 

"Although HHS guidance requires states to provide reasonable accommodations for Medicaid enrollees determined to be medically frail, it is unclear what criteria would be used to determine medical frailty, which is especially challenging for behavioral health conditions such as mental health and substance use disorders," Wen said. "So a key challenge in crafting those provisions is to accurately assess the functional status of people and the ways in which their behavioral and other health conditions might limit their ability to work."

To date, nine states have had work requirements approved by the Trump administration through section 1115 waivers; Utah is the most recent. The elderly and pregnant women are often granted exemptions to these requirements, but there still remains a large population with mental health conditions that could be in need of similar exemptions, the researchers said.