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Work requirements negatively affect Medicaid enrollees with behavioral conditions

Medicaid enrollees with behavioral and other health conditions were less likely to meet work requirements compared with those without health conditions, according to findings published in Health Affairs.

“In the context of the current intertwined epidemics of opioid misuse and suicide, people with behavioral health conditions deserve particular attention when states design and implement Medicaid work requirements,” the researchers wrote. “Medicaid is the largest payer of behavioral health services in the United States, and Medicaid enrollees have a higher prevalence of behavioral health conditions than those with private insurance do. Those who are subject to work requirements are thus likely to have a higher prevalence of behavioral health disorders than other populations do.”

Hefei Wen, PhD, assistant professor of health management and policy at University of Kentucky, and colleagues analyzed 2014 to 2016 data from the National Survey on Drug Use and Health (NSDUH) to determine the health status of Medicaid enrollees who could encounter work requirements. They also examined the prevalence of these behavioral and other chronic health conditions in the overall nonelderly adult population and enrollees who were unlikely to meet requirements as well as self-reported reasons for not working. Enrollees likely to be exempt from work requirements were excluded.

Of 13,058 Medicaid enrollees included in the analytic sample, the researchers identified a subsample of 7,062 enrollees who had worked less than 20 hours in the week prior to the NSDUH interview.

Analysis indicated that nonelderly adults with serious mental illness only, those with substance use disorder (SUD) only and those with comorbid serious mental illness and SUD were significantly more likely to be enrolled in Medicaid than those without health conditions (12.1%, 10.5%, and 13.8% vs. 8.4%). In addition, participants with chronic nonbehavioral conditions or poor health were more likely to be enrolled in Medicaid (10.2 % vs. 8.4 %).

Wen and colleagues also found that Medicaid enrollees with serious mental illness only, with SUD only and with comorbid serious mental illness and SUD were less likely to have worked 20 hours or more in the previous week than those without identified health conditions. (22.8%, 42.8%, and 32.3% vs. 49.2%). Enrollees with chronic nonbehavioral conditions were also 9.4 percentage-points less likely to have worked 20 hours or more in the previous week than those who had no identified health conditions.

When the researchers examined the participants’ reasons for not working they found that those with behavioral conditions were significantly more likely than those without such conditions to report that they were disabled for work (38.9% vs. 13.7%) and significantly less likely to report looking for work (31.6% vs. 40.8%), according to the results.

“Work requirements disproportionately affect a population that has an elevated prevalence of behavioral health conditions as well as other health conditions,” the investigators wrote. “If work requirements are to be a continued piece of Medicaid policy, it will be crucial that policy changes are also adopted to ensure that Medicaid covers a full continuum of evidence-based behavioral health services and that Medicaid enrollees with work-limiting conditions are given reasonable accommodations and exemptions.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.