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Research Letter
May 4, 2020

Assessment of Health Status and Barriers to Employment Among Medicaid Beneficiaries Not Meeting Work Requirements After Accounting for State Medical Frailty Exemptions

Author Affiliations
  • 1Office of Quality & Safety and Office of Ambulatory Care, New York City Health + Hospitals, New York
  • 2National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
  • 3Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
  • 4Solomon Center for Health Law and Policy, Yale Law School, New Haven, Connecticut
  • 5Institution for Social and Policy Studies, Yale University, New Haven, Connecticut
  • 6Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 7Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
  • 8Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut
JAMA Intern Med. Published online May 4, 2020. doi:10.1001/jamainternmed.2020.1039

As of February 2020, 28 states have sought or received US Centers for Medicare & Medicaid Services approval to impose work requirements as a condition of Medicaid eligibility.1 Centers for Medicare & Medicaid Services requires states to exempt medically frail Medicaid beneficiaries from work requirements2,3 but gives states flexibility in defining such exemptions. After accounting for state definitions of medical frailty exemptions, it is uncertain whether nonexempt beneficiaries not meeting work requirements are disproportionately ill or medically unable to work.4,5 We characterized the proportion of nonexempt beneficiaries not meeting work requirements and determined whether they (1) differ in health from beneficiaries fulfilling them and (2) do not meet the requirements for health-related reasons.

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