About 1.7 million Medicaid enrollees could lose coverage if work requirements are enacted as in House Republicans' debt ceiling bill, according to a new analysis.
KFF based its analysis on previous Congressional Budget Office (CBO) estimates. States could take steps to help keep people covered, the researchers said, but it's unclear how many would do so, as they would not receive federal matching funds to cover that group.
If states decided to keep that full 1.7 million group covered, it would shift $10.3 billion in Medicaid costs from the federal government to state governments. The CBO estimates that about half of that population would likely remain covered at the states' expense, according to KFF.
In the GOP debt bill, certain adults aged 18 to 55 who have Medicaid coverage would be required to work or participate in other activities, such as community service or job training, for 80 hours per month. KFF noted that 91% of people enrolled in Medicaid currently work.
The House of Representatives' bill is not expected to be passed in the Senate, but work requirements and other GOP priorities could be debated to secure a deal, KFF said.
"Leaders in the Senate and the Administration support passage of a clean debt ceiling bill; however, proposals to reduce federal spending could continue to be debated as part of the debt ceiling or as part of the regular budget process," the analysts wrote. "It is unclear whether this policy—or similar related policies—could end up being debated as negotiations over the debt ceiling and federal spending continue."
The report also noted that there could be several exemptions to the work requirements that are still unclear. For example, if adults with dependent children who secured coverage through the expansion population are exempted, the share of people who would lose coverage would be below 10%.
It's also not clear whether the requirements would be applied to nonexpansion eligibility groups, such as parents and people who are disabled and unable to work. The researchers estimate that these groups would likely be exempted from the requirements but could lose coverage anyway due to the reporting burden.
Coverage losses would likely vary significantly between states, according to the report.