Study: Adults impacted by Medicaid work requirements struggle to sustain employment 

A new study looks at the employment barriers for people subject to Medicaid work requirements. (Getty/designer491)

The people targeted by Medicaid work requirements are also those likely to struggle with barriers to employment, according to a new report. 

The Urban Institute examined survey data on 1,180 nondisabled adults enrolled in Medicaid to find the biggest challenges to employment. Of those who would not be exempted from work requirements, 60% worked in the past year but just 15% worked 20 or more hours per week for nearly all weeks. 

In addition, 19% worked 20 hours a week on “most” weeks. 


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States pursuing work requirements set minimums on employment as a condition of enrollment in Medicaid and many use 20 hours per week as a threshold, though 80 hours per month is more common, the researchers said. 

“It’s not enough to be working, but you have to have a minimum number of hours,” Michael Karpman, a senior research associate and the report’s author, told FierceHealthcare. 

RELATED: People with behavioral health conditions less likely to meet Medicaid work requirements, study finds 

This population, according to the study, reported barriers to both hiring and maintaining a job. For example:

  • One in five had not completed high school, restricting their options, and 25% reported multiple chronic illnesses that made it hard to hold down a position. 
  • About 43% are either black or Hispanic, which can also be a hiring barrier, according to the study. Nearly a quarter (22.3%) reported a lack of internet access to search for jobs and 14.6% lacked transportation to get to work. 
  • 15% of those likely to be subject to work requirements reported a criminal background and 7% had been incarcerated, which can also prevent employment, the study found.  

Karpman added that many of the survey respondents also said their employers put restrictions on their hours. 

RELATED: 4.4M would gain coverage if Medicaid were expanded nationwide, KFF finds 

These barriers put a spotlight on how crucial employment supports can be in conjunction with work requirements, according to the study.

However, that is a challenge for states, Karpman said, as the Centers for Medicare & Medicaid Services’ guidance on work requirements blocks states from using Medicaid funds for employment supports in demonstrations. 

Despite that, some are still finding ways to invest in these programs, he said. Virginia, for example, is seeking use Medicaid funds to offer employment supports through a state plan amendment, and Montana’s Medicaid program refers beneficiaries to these supports though it does not provide them directly. 

“I think it really underscores the importance of putting job training and education employment services at the center of efforts to increase employment,” Karpman said. “In general, I don’t think there has been really the substantial investment that is likely needed to boost employment.”