Key facts
- New federal Medicaid work requirements mandate 80 hours of work, school, or volunteering per month for ACA expansion enrollees.
- States can apply for federal exemptions based on high unemployment in certain counties.
- Missouri and Iowa have not adopted these hardship exemptions, despite having qualifying counties.
- Experts suggest political ideology and administrative burdens influence states' decisions to forgo exemptions.
- Historically, Medicaid work requirements have led to coverage losses without significant employment gains.
New federal work requirements for Medicaid, set to begin January 1, mandate that adults enrolled through the Affordable Care Act (ACA) Medicaid expansion must work, attend school, volunteer, or engage in other qualifying activities for at least 80 hours per month to maintain coverage. Federal exemptions are available for situations such as hospitalization, medical travel, natural disasters, or high unemployment.
While New York City has adopted a high-unemployment exemption for the Bronx, states like Missouri and Iowa are reportedly not implementing similar hardship exemptions, according to research by KFF. Experts suggest that political ideology, particularly a conservative stance favoring tying health insurance to employment, and the administrative burden of managing exemptions are key factors in these decisions.
Advocates express disappointment, arguing that the administrative burden is a less significant concern than the potential loss of healthcare coverage for residents. Historical data from Arkansas, which implemented work requirements in 2018, shows that over 18,000 people lost coverage by the end of that year, with no significant increase in employment observed.