Republicans in Congress are hustling to shepherd through a massive budget bill that includes a requirement that people on Medicaid submit proof they’re working.
Recent analyses suggest as many as 20,000 Granite Staters could lose coverage if that moves forward.
Here’s more on what Medicaid work requirements could mean for New Hampshire.
Who receives Medicaid in New Hampshire currently?
Medicaid is a safety-net health insurance program administered jointly by the federal government and the states. It provides coverage to more than 180,000 low-income adults, people with disabilities and others in New Hampshire.
The current bill in Congress would require people seeking Medicaid coverage to demonstrate that they’re working, volunteering or in school at least 80 hours a month to obtain coverage through Medicaid. The requirement wouldn’t apply to people who have a disability or meet certain other exceptions.
Most Medicaid beneficiaries are already working. According to the health policy organization KFF, about two-thirds of Medicaid recipients in the U.S. who don’t receive disability benefits are employed either full- or part-time. Most others are in school, caring for a family member or dealing with an illness or disability.
In New Hampshire, the state health department estimates a similar share — about 65% — of Medicaid beneficiaries are working.
What would the impact of work requirements be locally?
Republicans in New Hampshire and nationally have been pushing to add a work requirement to Medicaid for a long time, arguing that if a person is receiving tax-payer funded health care, and they’re able to work, they should.
“We're talking only here about able-bodied individuals that are capable of finding employment, developing those skills, and helping themselves and their families move to self-sufficiency,” said New Hampshire Executive Councilor John Stephen, a Republican who has supported similar work requirements at the state level.
Critics, including Democrats and some health providers, point out the vast majority of people with Medicaid are either working or unable to — and many people could lose coverage even if they’re eligible, just because they fail to comply with the reporting requirements or have trouble navigating the process.
Recent estimates from KFF and the Urban Institute suggest anywhere from 12,000 to 20,000 Granite Staters could lose coverage if a federal work requirement took effect.
Melissa Kimball, the deputy director of Hope for New Hampshire Recovery, a recovery center in Manchester, worries that would make it harder for people to receive treatment for substance use.
She said many people already lose coverage because they have trouble keeping up with the existing requirements, like submitting proof of residency, bank statements and other documents that not everyone can easily access.
While the congressional bill has an exception to the work requirement for people with substance use disorder, it’s not clear what they would need to do to prove that. Kimball says that in itself could be a big barrier.
“The mental health agencies are already so overwhelmed,” she said. “So to get any diagnosis or to be able to prove someone is suffering with a chronic substance use disorder — it would, I would assume, take months.”
She also said people in recovery often have a harder time finding work, because of gaps in their resume or a criminal record related to past substance use.
What is the track record of Medicaid work requirements?
Arkansas became the first state to roll out a Medicaid work requirement in 2018. Research has found it resulted in 18,000 people becoming uninsured, with no noticeable increase in employment.
Many of those who lost coverage hadn’t heard about the policy, weren’t sure it applied to them, lacked internet coverage or had other difficulties proving compliance, according to a 2019 study in the New England Journal of Medicine.
New Hampshire briefly tried to roll out a work requirement of its own in 2019, but state officials suspended the policy before it could take effect. Despite an extensive public awareness campaign, around two-thirds of people — some 17,000 individuals — had not submitted proof of eligibility and could have abruptly lost coverage. A judge later permanently halted the policy.
Jess Williams with New Hampshire Fiscal Policy Institute, a nonprofit research group, said some low-wage workers may struggle to meet the work requirements because of inconsistent schedules.
“Those with lower incomes may be more likely to work unstable jobs, seasonal jobs, involuntary part time jobs,” she said, such as a home health aide whose hours suddenly drop when a client enters a nursing home.
Stephen, the New Hampshire executive councilor who previously ran the state Department and Health and Human Services, said work requirements could be implemented in a way that doesn’t cut eligible people off from coverage. He said that could be done with the right collaboration between state agencies and the private insurance companies that manage New Hampshire’s Medicaid program.
“There are going to be changes that we’ll have to make to make sure that those that, for example, move from one home to another — that there's not any issues with eligibility,” he said.
