Obtaining Medicaid coverage in Alabama could become a Catch-22 situation if the state moves forward with additional work requirements, according to health policy researchers.
Alabama is currently seeking federal permission to require that parents and caregivers who rely on Medicaid work 20 to 35 hours a week or prove they are looking for work. The state already has one of the strictest Medicaid eligibility requirements in the country, where only parents and caregivers making 12% of the poverty line or less qualify for the program.
Researchers at the Georgetown Health Policy Institute found (PDF) that with combining the two policies with Alabama's minimum wage, parents would earn too much money to qualify for the program and lose coverage.
“Less than a quarter of Alabama adults living below the poverty line are covered by employer-sponsored insurance,” researchers said. “Even if parents are eligible for an employer-sponsored plan, they likely will not be able to afford one, at least not one that would provide adequate coverage for needed health services.”
In its 1115 Medicaid demonstration proposal, Alabama said the requirements are intended to improve physical and mental health, which can be negatively impacted by unemployment.
But Georgetown researchers said Alabama's own projections show that if the proposal is approved, 8,700 of Alabama's poorest residents would lose their Medicaid coverage within one year.
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The proposed requirements would disproportionately hit Alabama women and minorities the hardest, they added. At least 85% of the state's Medicaid population are women and almost 60% are black. Young parents under 30 also comprise around one-third of the Medicaid population.
The group said the children of those parents would be hurt as well.
"When their parents lose health coverage, children suffer," the researchers said. "The families face increased debt, and children are less likely to visit the doctor regularly and more likely to become uninsured themselves."