medicaid Work Requirements: A Closer Look at Employment Status in 2023

Most Medicaid adults are working,but work requirements could create administrative hurdles adn coverage loss.

A recent analysis sheds light on the work status of adults enrolled in medicaid, particularly in the context of ongoing debates about work requirements. While these requirements were previously withdrawn by many states, Georgia currently maintains a waiver, and other states are considering similar policies, especially with potential changes in federal policy on the horizon.

The analysis updates earlier data, revealing that in 2023, nearly two-thirds of adults aged 19-64 with medicaid coverage were employed. Additionally, almost three in ten were not working due to caregiving, illness, disability, or school attendance-reasons that frequently enough qualify for exemptions under existing work requirement policies. The data suggests that only a small percentage of Medicaid adults woudl not meet work requirements or qualify for an exemption. However, a meaningful number of eligible enrollees could still risk losing coverage due to administrative burdens associated with reporting requirements.

Work Status of Medicaid enrollees

The data indicates that most Medicaid adults under 65 are actively participating in the workforce.Specifically, among adults under 65 with Medicaid who do not receive benefits from Social Security disability programs like Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), and who are not also covered by Medicare, 92% were either working full or part-time (64%) or were not working due to caregiving, illness, disability, or school attendance. Only 8% reported being retired, unable to find work, or not working for other reasons.

“In 2023, most Medicaid adults under age 65 were working.”

Factors Influencing Employment

Health status,age,and education level significantly impact employment rates among Medicaid adults. Seven in ten people in excellent health, aged 30-39, and with a college degree were employed, compared to 44% of those in fair health, less than half of adults aged 55-64 (48%), and 56% of those who did not complete high school. Parents were also more likely to be working than adults without dependent children (72% vs. 58%),partly due to being younger and less likely to have a disability. Employment rates also vary by geographic region, metro status, and race/ethnicity.

Disability and Employment Barriers

Medicaid enrollees with disabilities face significant challenges in securing employment. Disability is defined as having at least one serious difficulty with hearing, vision, cognitive functioning, mobility, self-reliant living, or self-care. Approximately one-third (32%) of Medicaid enrollees aged 19-64 with a disability receive disability income (SSI or SSDI), leaving 68% without such income. Medicaid adults with a disability are less likely to work than those without a disability (37% vs. 68%).

The number and type of functional limitations also affect workforce participation.While nearly half (48%) of Medicaid adults with one disability were working, fewer than one in five (17%) with four or more disabilities were employed. Similarly, over four in ten Medicaid adults with visual or hearing disabilities were working, while those with difficulties related to independent living and self-care had the lowest employment rates (21% and 16%, respectively). Medicaid offers various services to help people with these needs work, so losing Medicaid could make employment harder or impractical for these adults.

Characteristics of Working Medicaid adults

Most Medicaid adults who work are employed full-time (at least 35 hours per week), but those working part-time often face obstacles to full-time employment. Among working Medicaid adults, 69% worked full-time, and half worked full-time for the entire year (at least 50 weeks). Many part-time workers (31% of all workers) cited reasons such as shorter work weeks (16%), slack business conditions (12%), or inability to find full-time work (7%). Childcare problems (9%) and other family or personal obligations (22%) were also factors.

Many Medicaid adults are employed by small firms and are not eligible for employer-sponsored health insurance. in 2023, 46% of medicaid workers were employed in firms with fewer than 50 employees, which are not subject to ACA penalties for not offering affordable health coverage and are less likely to offer health insurance. In 2022, just over half (53%) of firms with fewer than 50 employees offered health insurance, compared to 98.7% of firms with 100 or more employees. Additionally, many Medicaid workers are employed in industries with historically low ESI offer rates, such as agriculture and service industries (46%). Among workers in farming, fishing, and forestry, only about 41.4% were eligible for insurance at their job in 2023, and among those in service occupations, just over half (55.6%) were eligible. access to job-based insurance for part-time workers is even more limited, with fewer than 38.4% eligible in 2023. Even if eligible, some workers may not take up the offer because it is not affordable.

Medicaid adults who work full-time are often eligible for Medicaid in expansion states because they work low-wage jobs and meet income eligibility criteria. An individual working full-time at the federal minimum wage ($7.25 per hour) earns an annual salary of $12,688, which is below the Medicaid eligibility limit of 138% of the Federal Poverty Level ($15,650 for an individual; $32,150 for a family of four) in states that have expanded Medicaid under the ACA. Though,working adults might potentially be ineligible in non-expansion states where eligibility limits are much lower,and childless adults are frequently enough not eligible.

By Amelia Stone | WASHINGTON – 2024-07-03