Study: Older, less educated at risk in Medicaid changes
FRANKFORT, Ky. (AP) — As Kentucky prepares to impose the nation’s first work requirements for Medicaid, a new study suggests the people most likely to lose their coverage are older and in poor health while those most likely to keep their insurance are younger and in better condition.
An analysis of Census Bureau data by the Urban Institute estimates 174,000 people will likely be exempt from Kentucky’s Medicaid work requirements. Their average age is 34, and 85 percent have at least a high school degree. About 20 percent report one or more serious health limitations.
The institute projects about 357,000 people won’t have an exemption. Of those, 188,000 are not working and most at risk of losing coverage. Their average age is 45, with 48 percent of them older than 50. Seventy-six percent of them don’t have a car, household access to the internet, a high school diploma or have serious health limitations or live with someone who does.
The reason the populations look like that, according to lead researcher Anuj Gangopadhyaya, is the way Kentucky’s rules about work requirements are written. They exempt full-time students and parents who are primary caregivers and tend to be younger people.
“Those who are (not exempt) are older, they are not in school, they don’t have a child in their household under the age of 18. So just by the way the waiver’s language is defined, that’s how these groups are being classified,” Gangopadhyaya said.
Republican Gov. Matt Bevin’s administration has estimated between 100,000 and 130,000 people will be exempted from the work requirements. Officials expect about 95,000 people will lose their Medicaid benefits after five years. Some will lose coverage because they don’t comply with the requirements. Others will lose eligibility because they get a job and earn too much money to qualify for the program.
Kristi Putnam, who is overseeing the program, said the state estimates work requirements will apply to more than 224,000 people. They also expect more than 408,000 jobs to become available in Kentucky over the next five years, according to data from the Bureau of Labor Statistics. Eastern Kentucky is the only region of the state projected to not have enough jobs for everyone. But the analysis also included more than 100,000 jobs that could not be assigned to a specific region because they are attributed to multiple areas.
“Kentucky HEALTH community engagement supports also will be available to those who are under-employed to help strengthen their employment opportunities and skills/education attainment,” Putnam said. “These progressive policies should result in the undebatable benefit of disqualifying some of our Medicaid recipients due to increased employability, salary, and economic stability.”
The Urban Institute is a Washington-based nonprofit focusing on social and economic policy. Their review of Kentucky’s Medicaid population was paid for by the Robert Wood Johnson Foundation.
The study relied on data from the American Community Survey, but it has some limitations. The rules for work requirements apply to full-time students. But the data does not distinguish between full-time and part-time, so the study counted all students as exempt. That’s likely an overestimate.
The work requirements also exempt pregnant women, a population not counted in the data.
And, crucially, the work requirement rules exempt the “medically frail,” which could not be counted in the data. Kentucky’s application to the federal government said this could include people with active cancer, aplastic anemia, blood clotting disorders, chronic alcohol or drug abuse and mental illness. But it’s unclear how those rules will be applied. It’s possible a number of people the study identified as not exempt from the work requirement would fall into one of those categories.
“We try to be straightforward with the limitations we have with the data,” Gangopadhyaya said. “We think this is an important analysis.”
The study also identified another group: about 169,000 people who would not be exempt from the work requirements but who already have a job. It would be easier for them to meet the requirements and not lose coverage. Of those, 36 percent reported they worked less than the required 80 hours per month.
But working isn’t the only way to fulfill the requirements. People can also participate in community service, attend school or take job training classes.
One thing all three groups have in common: no access to high-speed internet. That could make it difficult to document their compliance with the work requirement, since state officials want people to use a mobile-friendly website to track that data. But people can also log their hours by mailing in printed forms or by visiting county offices of the Department of Community Based Services.