ANN ARBOR, Mich. - New Medicaid rules in several states mean low-income people will have to work, or prove they're too unhealthy to work, to receive health coverage. Other states want permission to require the same, which could affect millions of Americans living in or near poverty.
Before these requirements get into full gear, a team of University of Michigan researchers is offering specific recommendations to help states ensure that work requirements don't harm the health of people enrolled in Medicaid.
The chance of such harm from losing Medicaid coverage forms the basis of a court case that has put Kentucky's Medicaid work requirement on hold and led to a public comment period that closes August 18.
The U-M team, which has studied Medicaid for years , published their recommendations in the New England Journal of Medicine . Their prior work on Michigan's Medicaid expansion showed that half of enrollees already work, and many others have health problems that limit their ability to work.
"We wanted to address the essential question: 'If we're going to have work requirements, then how can states implement them in the most humane way, so that the requirements focus on those who are more able to work and are less likely to experience worsening health if they lose coverage?'," asks John Z. Ayanian, M.D., M.P.P., lead author of the article and director of the U-M Institute for Healthcare Policy and Innovation. "We based our recommendations on the evidence we have about the current Medicaid expansion population. We hope state policymakers will take our recommendations into account as they seek to create reasonable, sustainable programs."
Ayanian and his co-authors are all general internal medicine physicians who provide primary care to patients at Michigan Medicine, U-M's academic medical center. Their recommendations focus in part on the new role that physicians would play in states that implement Medicaid work requirements.
The team recommends that states:
Ayanian and co-authors Renuka Tipirneni, M.D., M.S., and Susan Goold, M.D., M.A., M.H.S.A., note that as work requirements become more widespread as part of ongoing or new Medicaid expansion programs, the details of implementation will become more important. All are faculty members in the Division of General Internal Medicine at the U-M Medical School, and members of IHPI.
"If the goal is to help people improve their economic standing in life and become self-sufficient, they'll need support to do so," says Ayanian, who also holds faculty appointments in the U-M Ford School of Public Policy and School of Public Health. "States should prevent potential harm that will arise if people with chronic conditions lose their Medicaid coverage, and therefore their access to health care providers and medications, especially if the economy changes."
Adds Goold, "If the goal is to provide a 'leg up' to economic self-sufficiency rather than a 'hand out,' providing health insurance through Medicaid is just one piece of providing such support. Child care, transportation, education and training, as well as health issues, present obstacles to self-sufficiency."
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New England Journal of Medicine