Lori Kelly, a resident of Harrisburg, North Carolina, is facing challenges due to her deteriorating eyesight, which has hindered her ability to find consistent work.
At 59, she had to shut down her nonprofit circus arts school last year, unable to manage the paperwork. She briefly worked at a pizza shop, but currently, her primary income comes from sorting recyclables at local concerts, which isn’t a year-round opportunity.
“This place knows me and loves me,” she expressed about her current job. “I don’t have to explain why I can’t read.”
Living in a camper on an income of less than $10,000 annually, Kelly relies on Medicaid for her arthritis treatments and anxiety medications, as well as for managing her high blood pressure through regular medical visits.
However, she’s anxious about upcoming changes to Medicaid regulations that will require many beneficiaries, including herself, to meet a work requirement of at least 80 hours monthly, including volunteering, attending school, or engaging in other qualifying activities.
“I’m scared right now,” she admitted.
Prior to these changes, some Republican lawmakers indicated that younger unemployed individuals were exploiting the Medicaid program. They stated it wasn’t designed for someone like “a 29-year-old man sitting on the couch playing video games,” as remarked by House Chairman Mike Johnson.
Nonetheless, the reality for many adults aged 50 to 64, particularly women, is that job requirements may pose significant barriers to keeping their Medicaid coverage, according to Jennifer Tolbert from KFF, an organization that focuses on health issues. She noted that this could put many at risk of losing their Medicaid benefits, consequently threatening their health and financial stability.
Beginning next January, nearly 20 million low-income Americans across 42 states and Washington, D.C., will face new activity requirements to secure or maintain their Medicaid coverage.
Some states, including Alabama, Florida, and Texas, are exempt from these work rules as they haven’t expanded their Medicaid programs to include additional low-income adults under the Affordable Care Act.
The Congressional Budget Office, a nonpartisan agency, predicts that these regulations could decrease Medicaid enrollment by at least 5 million individuals over the next decade. Critics argue that these labor requirements are significant contributors to coverage losses stemming from a Republican budget law aimed at cutting nearly $1 trillion to fund tax cuts benefiting the wealthy.
“We’re talking about saving money at the expense of people’s lives,” said Jane Tavares, a researcher in gerontology. “Work requirements are simply a tool for that.”
Andrew Nixon from the Department of Health and Human Services stated that requiring “able-bodied adults” to work would help ensure the “long-term sustainability” of Medicaid, while still allowing coverage for vulnerable populations, including those facing medical or personal difficulties.
According to a recent report, Medicaid expansion has been crucial for middle-aged adults who would otherwise struggle to obtain insurance. It currently covers one in five individuals aged 50 to 64, providing health insurance before they reach Medicare eligibility at age 65.
Tolbert pointed out that women on Medicaid aged 50 to 64 often find it harder to maintain coverage and tend to have greater healthcare needs compared to younger women.
She emphasized that many of these middle-aged women may not be able to accumulate the necessary work hours due to caregiving responsibilities or health issues.
Tavares and other researchers found that only 8% of the overall Medicaid population deemed “able-bodied” are not working. This group mainly consists of women who have withdrawn from the labor market due to poverty and caregiving duties, with a quarter of them over 50.
“These are not healthy young people just hanging out,” the researchers clarified.
Moreover, making it more challenging to maintain Medicaid coverage can exacerbate health issues that directly affect one’s ability to work. Even after losing coverage, chronic health conditions still require management, as noted by Tolbert.
Health issues often surface before individuals qualify for Medicare, leading to a cycle where seniors lacking funds for health problems get sicker, ultimately increasing Medicare costs, according to health policy researchers.
Many adults in their 50s and early 60s are no longer employed because they are fully engaged in caregiving roles, often referred to as the “sandwich generation,” juggling duties for both children and aging family members.
The Republican budget law does offer a narrow exemption for some caregivers from Medicaid work requirements, though Nicole Jolwich from Caring Across Generations worries many who should qualify for exemptions will miss out.
“We’re going to continue to see family caregivers get sick and abandon their care, leading to more families in crisis,” Jolwich expressed.
Paula Wallace, 63, from Chidester, Arkansas, spent most of her life in the workforce but now dedicates her time to assisting her husband who has advanced cirrhosis. Recently obtaining coverage through Medicaid expansion, she is now faced with the new work requirement, which she finds puzzling.
“I’m his only caregiver, so I can’t go out and work away from home,” she said.
Though her husband receives Social Security Disability Insurance, the law states she should be exempt as a full-time caregiver for a disabled individual. However, there are no clear federal guidelines on how to define that exemption, and experience in Arkansas and Georgia, the only state with a Medicaid work program, indicates that many beneficiaries struggle within this complex system.
“I’m very concerned,” Wallace shared.
