As more states gear up to impose work requirements (15 states thus far have applied, with waivers approved and implemented in Arkansas, Indiana and New Hampshire; approved but not implemented in Arizona, Kentucky, Michigan and Ohio; and pending in Alabama, Mississippi, Oklahoma, South Dakota, Tennessee and Utah) and resistance grows against them, new data suggests the requirements aren't very effective.

In fact, despite assertions to the contrary by Health and Human Services Secretary Alex Azar, the Center on Budget and Policy Priorities reports that not only have individuals kicked off Medicaid because of unsatisfied work requirements not gotten health care coverage through a new employer, they haven't been able to find jobs either.

According to the data, only about 2,000 of the 18,000 or so Arkansans who lost their health care last year reenrolled in Medicaid this year, and very few of those 18,000 (1,981) found jobs. That leaves some 16,000 others dealing with being uninsured.

However, when asked about the fate of those who lost coverage, Azar said in a House hearing last week, “we do not yet have data as to why they fell off the program.” Two days later, at the Senate Finance Committee, Azar instead pointed to the low share of people who lost coverage last year and reenrolled in January and said, “That seems a fairly strong indication that the individuals who left the program were doing so because they got a job.”

And the state data are probably overstating the number of people who found work, since the New Hire Database includes people who have worked for just hours or days; it doesn't capture wage or hour information, so doesn't indicate whether the new jobs are temporary or even seasonal; and also doesn't indicate whether the individuals are working at new jobs and simply changed employers.

Meanwhile, the Trump administration is being sued over work requirements—now by three states, as New Hampshire joins Arkansas and Kentucky in having active lawsuits filed against the work requirements. The judge who already ruled against a Medicaid work requirement imposed in Kentucky last June has promised to rule on such requirements for both Kentucky and Arkansas by the end of this month. His decision could have broad repercussions for other states considering adding their own work requirements.

U.S. District Judge James Boasberg is considering not only a revised federal approval for Kentucky, but also Arkansas' requirements. Kaiser Health News reports that Boasberg has said that Azar's approval of Kentucky's plan “failed to consider whether the strategy would 'help the state furnish medical assistance to its citizens, a central objective of Medicaid,'” adding that Boasberg “said promoting health generally or helping someone get a job was not the point of the state-federal program created in 1965.”

The National Health Law Program is representing the New Hampshire residents, and arguing that “the administration wants to weaken the Medicaid program through work requirements.”

“This approval will not promote coverage, but it will result in significant coverage losses, and that is the administration's goal—to weaken the Medicaid program and cull people whom it deems unworthy from it,” NHeLP legal director Jane Perkins said in a statement.

While Azar has said in a speech that “We know there is a strong connection between finding work and improving physical and mental health, and we want to pursue these goals in all our health and human services programs,” CBPP points out that the loss of health coverage makes it less likely, not more, that people will be able to work—and certainly to work sufficient hours to satisfy work requirements to maintain health coverage.

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Friction grows over Medicaid work requirements

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