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Research Letter
Health Care Policy and Law
November 2018

Analysis of Work Requirement Exemptions and Medicaid Spending

Author Affiliations
  • 1Cambridge Health Alliance, Cambridge, Massachusetts
  • 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Medicine, Harvard Medical School, Boston, Massachusetts
  • 4Department of Medicine, City University of New York at Hunter College, New York
JAMA Intern Med. 2018;178(11):1549-1552. doi:10.1001/jamainternmed.2018.4194

To date, 4 states (Arkansas, Indiana, Kentucky, and New Hampshire) have federal waivers to impose work requirements as a condition of eligibility for Medicaid (although a judge recently stayed Kentucky’s waiver1), and 7 other states (Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin) have submitted waiver applications. The governor of Kentucky2 claimed that excluding “able-bodied” adults will reduce Medicaid enrollment by 16%, ensuring the program’s “fiscal sustainability.” However, such claims may be overstated because many Medicaid enrollees already work, and waivers have specified that many others (eg, people with disabilities and caregivers of young children) will be exempted. To our knowledge, no studies have quantified the potential influence of work requirements on Medicaid spending. We estimated the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented with the exemptions specified in approved waiver applications, and we calculated current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers.

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