New Approaches In Medicaid: Work Requirements, Health Savings Accounts, And Health Care Access

Abstract

Alternative approaches in Medicaid are proliferating under the Trump administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and Medicaid expansion. Our sample consisted of 2,739 low-income nonelderly adults in three Midwestern states: Ohio, which expanded eligibility for traditional Medicaid; Indiana, which expanded Medicaid using health savings accounts called POWER accounts; and Kansas, which has not expanded Medicaid. We found that coverage rates in 2017 were significantly higher in the two expansion states than in Kansas. However, cost-related barriers were more common in Indiana than in Ohio. Among Medicaid beneficiaries eligible for Indiana’s waiver program, 39 percent had not heard of POWER accounts, and only 36 percent were making required payments, which means that nearly two-thirds were potentially subject to loss of benefits or coverage. In Kansas, 77 percent of respondents supported expanding Medicaid. With regard to work requirements, 49 percent of potential Medicaid enrollees in Kansas were already employed, 34 percent were disabled, and only 11 percent were not working but would be more likely to look for a job if required by Medicaid. These findings suggest that current Medicaid innovations may lead to unintended consequences for coverage and access.

Assessment of Medicaid Beneficiaries Included in Community Engagement Requirements in Kentucky

“…To our knowledge, this method had not been possible in prior work. 8,12,13,14,15 For example, a 2018 article using data from the 2014 Survey of Income and Program Participation estimated that approximately 28 000 potentially exposed able-bodied individuals did not meet CE requirements at the time. 13 Our estimate of the number of beneficiaries not currently meeting CE requirements was nearly twice as large even after explicitly accounting for individuals who may self-identify as potentially medically frail.…”

The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion

“…My analysis suggests that inclusion of later years is important, as individuals appeared to shift their investments in healthy behaviors starting 4 years postexpansion. At a time of uncertainty regarding the future of Medicaid (Sommers, Fry, Blendon, & Epstein, 2018) and the nation's general health policy directions, this study provides important evidence that increasing access to public health insurance may increase low-income adults' preventive care utilization and reduce their engagement in risky health behaviors in the long run.…”

Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements

“…Data is up to date as of January 16, 2020. See appendix table A1 (online appendix) for unabridged version of this table. evaluated sociodemographic and labor market characteristics of Medicaid recipients or low-income individuals (Carroll 2018;Garfield et al 2019;Greene 2019;Silvestri, Holland, and Ross 2018;Sommers et al 2018;Tipirneni, Goold, and Ayanian 2018;Wen, Saloner, and Cummings 2019), there has been little research examining time spent on other activities that will also satisfy the new requirements, such as caregiving for the elderly/disabled, volunteering, and education. Also, most studies have not quantified whether the total hours spent on such activities would satisfy commonly proposed thresholds.…”