Significantly fewer people in Missouri than in other participating states would be affected if Medicaid recipients were required to take part in some kind of work, volunteering or other tasks in order to maintain their coverage, according to a policy brief published by a team from the Center for Health Economics and Policy at Washington University in St. Louis.
Many of those who would be affected may face limited job prospects due to poor health or lack of education, according to the brief, which was published in the wake of Senate Bill 948, proposed in January by state Sen. David Sater (R-Cassville).
“Our research identifies some of the characteristics of people potentially subject to a work requirement, and shows that the number could be limited in part because Missouri did not expand Medicaid,” said Timothy McBride, professor at the Brown School.
The research team — McBride; Linda Li, statistical data analyst; Leah Kemper, manager of the Center for Health Economics; and Abigail Barker, research assistant professor — looked at the U.S. Census Current Population Surveys from March 2016 and March 2017 to estimate the number of Missourians who would be affected by SB 948.
As it does in Kentucky, Indiana and Arkansas — all of whom have adopted similar measures — the Missouri bill, if passed, would require able-bodied Medicaid participants aged 16-64 to complete at least 80 hours each month of a combination of work, school, job searching, child care or volunteer service in order to maintain coverage.
Unlike the aforementioned states, Missouri is not a state that expanded Medicaid under the Affordable Care Act (ACA), meaning Missouri has not expanded the number of people who are enrolled in Medicaid, as other states have. Medicaid in Kentucky, Indiana and Arkansas covers non-disabled, childless adults and low-income parents earning up to 138 percent of the federal poverty level.
Missouri does not cover childless adults (unless they are elderly, disabled or pregnant), and covers low-income parents and caretakers earning less than 23 percent of the federal poverty level. At most, the Missouri work requirements would be applied to fewer than 102,000 people. Of those, the researchers estimate that about 83,000 people are not currently meeting the proposed 20-hour-per-week work requirement, and would be affected by the proposed rules.
“States have been allowed to expand Medicaid to individuals who don’t necessarily fall into traditional eligibility guidelines,” Li said of the expansion states. “A lot more able-bodied adults under a higher poverty level in these states are eligible for coverage than in Missouri.”
For example, when Kentucky expanded access, 462,000 additional able-bodied people began receiving coverage. That is in addition to the able-bodied people who qualified before the expansion. All of these people could be affected by the work requirement unless they qualified for an exemption or worked 80 hours per month.
The researchers also found that in Missouri, nearly half of those who would be affected by SB 948 reported being in fair or poor health, and more than half have, at most, a high school degree. One-third live in rural areas, where work and volunteer opportunities may not be robust.
“The data shows that the job prospects of some of them may be constrained by a lack of job skills and by their health status.” McBride said. “More analysis needs to be done on the implementation steps for this potential policy change.”