News Center for Advancing Health Services, Policy & Economics Research Health Equity

Medicaid Work Requirements: What Would the Impact be in Missouri on Enrollment, Costs and Health?

Written by Linda Li, MPH, Abigail Barker, PhD, Leah Kemper, MPH, Timothy McBride, PhD | February 2019

In 2018, the Centers for Medicare and Medicaid Services (CMS) announced support for state efforts to condition Medicaid coverage on fulfilling a work requirement. For the first time in the program’s history, certain beneficiaries can be required to participate in work or work-related activities for a minimum number of hours in order to maintain eligibility for coverage. To date, CMS has approved Medicaid work requirements in eight states (AR, AZ, IN, KY, ME, MI, NH, WI) and eight other states are pending approval.

In Missouri, legislation to enact a work requirement is also currently being considered (Senate Bill 76). In a series of three policy briefs, the Center for Health Economics and Policy explores the impact that a Medicaid work requirement would have in Missouri.

In ‘The Demographics of Missouri Medicaid: Implications for Work Requirements’, the authors find that a limited number of people would be impacted by Medicaid work requirements in Missouri. In addition, the limited number of Missourians who would be affected by the work requirement may also face challenges obtaining employment.

To date, states in which Medicaid work requirements have been approved have all expanded Medicaid to cover non-disabled childless adults and low-income parents up to 138% of the Federal Poverty Level (FPL), or have eligibility levels near that amount (Wisconsin). Since Missouri has not adopted Medicaid expansion, its program does not cover childless adults (unless they are elderly, disabled, or pregnant) and current eligibility levels for low-income parents and caretakers are set at less than 23% of FPL ($5,460 per year for a family of four in 2018). As pregnant women, full-time students, primary caretakers of dependents, the chronically homeless, and those deemed “medically frail” are exempt from the work requirement, Medicaid work requirements in a low-eligibility Medicaid non-expansion state such as Missouri would look very different from those in expansion states.

In a second brief, ‘Weighing the Cost Savings of Medicaid Work Requirements in a Non-Expansion State’, the administrative costs of implementing Medicaid work requirements are explored, along with the possible gains and losses to Missouri’s state revenue in the short and long term. The authors find that in non-expansion state like Missouri, costs may outweigh any potential savings, and recipients are at greater risk of losing health coverage and becoming uninsured.

Finally, in the Center’s third brief, ‘Medicaid Work Requirements: The Relationship between Work and Health’, the authors assess the relationship between work and health and find that although work may be beneficial to the health of some, it may not be for all. Whether work requirements in Medicaid promote health and align with the aims of the program has become a central question in the current policy debate.

These three briefs provide a deeper examination of potential policy implications for Missouri and add to the national dialogue on work requirements for Medicaid as few studies have focused on the implications of a work requirement in a state that has not expanded Medicaid. The findings from these three briefs may help to inform policymakers by illustrating potential outcomes for Medicaid participants and the State of Missouri if a work requirement were to be passed and implemented.