Changes in Medicaid Rules Create Concerns for Low-Income Individuals

Lori Kelly, a 59-year-old resident of Harrisburg, North Carolina, is facing challenges due to her declining eyesight, which has affected her ability to find consistent employment. Last year, she had to close her nonprofit circus arts school because she could no longer manage the paperwork. Since then, she took a few shifts making dough for a local pizza shop, but her primary source of income now comes from sorting recyclables at concert venues. Unfortunately, this job isn’t year-round.

“This place knows me and loves me,” Kelly expressed about her employer. “I don’t need to explain why I can’t read.”

Living on less than $10,000 a year in a camper, she credits her Medicaid health insurance for covering her arthritis and anxiety treatments, as well as allowing her to manage her high blood pressure with a doctor’s help.

However, she’s anxious about the new requirements set to take effect next year, which will compel millions, including herself, to work at least 80 hours monthly or engage in some qualifying activities to keep their Medicaid coverage. “I’m scared right now,” she admitted.

Before these changes were legislated, some Republican lawmakers suggested that younger unemployed individuals were exploiting government healthcare benefits aimed at low-income and disabled citizens. House Speaker Mike Johnson even remarked that Medicaid shouldn’t be meant for “a 29-year-old guy sitting on the couch playing video games.”

In contrast, Jennifer Tolbert, an associate director at KFF, noted that adults aged 50 to 64, particularly women, stand to be most affected by the new requirements. For Kelly and others like her, meeting job expectations can pose a significant hurdle to maintaining their health coverage, potentially putting their health and financial stability at risk.

Beginning next January, nearly 20 million low-income Americans across 42 states and Washington, D.C., will need to fulfill activity requirements to either gain or retain Medicaid health coverage.

Some states, like Alabama and Florida, won’t have to implement these work rules because they haven’t expanded Medicaid under the Affordable Care Act to include more low-income adults.

The Congressional Budget Office, which is nonpartisan, predicts that these work requirements will decrease Medicaid enrollment by at least 5 million over the next decade. Critics argue that these work rules are the primary reason for coverage loss in the Republican budget law, which cuts around $1 trillion to offset tax cuts mainly benefiting the wealthy and bolster border security.

“We’re talking about saving money at the expense of people’s lives,” remarked Jane Tavares, a gerontology researcher from the University of Massachusetts Boston. “Work requirements are just a tool to that end.”

Andrew Nixon, a spokesperson for the Department of Health and Human Services, stated that requiring “able-bodied adults” to work would help ensure Medicaid’s sustainability while also maintaining coverage for vulnerable groups. He mentioned that individuals with disabilities, caregivers, pregnant and postpartum people, and fully disabled veterans would be exempted from these rules.

Research from Georgetown University highlights that Medicaid expansion has been a crucial support for middle-aged adults who might otherwise lack insurance. The program currently covers one in five Americans aged 50 to 64, giving them health access before transitioning to Medicare at age 65.

Tolbert remarked that women on Medicaid in the 50 to 64 age group often struggle more than younger women in maintaining their coverage and generally have a higher need for healthcare services.

Many of these middle-aged women find it challenging to meet work hour requirements due to caregiving responsibilities or health issues that limit their employment capabilities.

Research indicates that only 8% of those in the broader Medicaid population considered “able-bodied” are not employed. This demographic mainly consists of women who are low-income and have stepped away from employment to care for others, with one in four being over 50.

The researchers clarified, “These are not healthy young people just hanging out.”

Additionally, the potential difficulty in retaining Medicaid due to untreated health issues could indeed hinder the affected individuals’ ability to work. Even if this group loses their health coverage, they will still need to manage any chronic conditions.

Health challenges often onset before individuals reach Medicare eligibility.

If seniors can’t afford to address their health issues prior to age 65, they may become sicker and incur higher costs for the Medicare program, as highlighted by health policy researchers.

Many in their 50s and early 60s have ceased employment because they devote their time to caring for children or aging family members, a demographic often referred to as the “sandwich generation.”

While the Republican budget law provides some caregiver exemptions from Medicaid work rules, experts like Nicole Jolwich from Caring Across Generations believe the criteria are overly narrow and fear that many deserving individuals might be overlooked.

“We’re going to see family caregivers getting sick and abandoning their care, leading to more crises among families,” she warned.

Paula Wallace, a 63-year-old from Chidester, Arkansas, shared that after a lifetime of work, she now spends her days supporting her husband in managing his serious health condition. She’d been uninsured for years but recently obtained coverage through Medicaid expansion, which now requires her compliance with the new work obligations. Still, she finds it hard to see how that’s feasible.

“I’m his only caregiver, so I can’t go out and work away from home,” Wallace noted.

Her husband’s receipt of Social Security Disability Insurance means she should be exempt from work requirements, yet specific guidelines for this exemption are not yet defined by federal officials. Experiences from Arkansas and Georgia, the only states with Medicaid work programs, demonstrate that many enrolled individuals find it tough to navigate these complex systems.

“I’m very concerned,” Wallace expressed.