Policymakers at both the federal and state level are putting forward proposals to require adults to meet work requirements or community engagement requirements as a condition of enrolling in and maintaining Medicaid. While some seniors would be exempt based on their age, older adults not yet eligible for Medicare, people with disabilities, and family caregivers would be forced to navigate burdensome reporting requirements to stay eligible.
We’ve seen this policy before and we know the result: people, including older adults, will lose Medicaid. Though most people targeted by work requirements should remain eligible, the red tape alone will take away coverage from people who are already working, older adults who are retired or have difficulty finding work, people with disabilities, and family caregivers. Work requirements also operate as a job loss penalty: when workers lose their jobs, they lose their Medicaid due to these unnecessary requirements. Moreover, resources spent on implementing these bureaucratic hurdles will delay access to critical health, financial, and food support for everyone.
Work requirements would take away Medicaid from older adults ages 50 to 64
Nearly 1 in 5 Americans ages 50 to 64 get their health insurance through Medicaid, including more than 5 million older adults enrolled in Medicaid expansion under the Affordable Care Act. Work requirements would disproportionately harm older adults because they have higher rates of disability and greater health care needs and therefore may not be able to work, especially without access to health care.
- Almost half of adults ages 50-64 who rely on Medicaid have a disability. About 6 in 10 of these older adults do not receive SSI and would be subject to work requirements. Even those who are eligible for SSI or other disability benefits could get caught in the red tape and may not be automatically exempt from work requirements.
- Among older adults ages 50-64 enrolled in Medicaid expansion who are retired or not working, the vast majority (86%) report having a health condition that prevents them from working.
Older adults also have a harder time finding work. Work requirements would particularly punish older adults who lose their jobs or can’t find work by also taking away access to health care.
- Among Medicaid expansion enrollees ages 50 to 64, only 38% are working.
- More than 1 in 4 people enrolled in Medicaid expansion who are not working and are not disabled are over age 50 and the vast majority are women.
- Many older adults experience age discrimination and increasing difficulties finding work after the COVID-19 pandemic.
Work Requirements Would Penalize Older Adults Who Cannot Work
Medicaid saved Jeff’s life at a time when he needed it most. At age 60, Jeff’s decades long-career operating machinery for his family’s business ended abruptly following a series of heart attacks. While he awaited a decision on his Social Security disability claim, he found himself without income or health insurance. Living in rural Illinois, Jeff secured Medicaid through the expansion—covering two heart surgeries, cardiologist visits, and eight vital medications. He could not have afforded this care out-of-pocket. If Jeff had to meet Medicaid work requirements, it’s unclear how he could prove that he was disabled and could not work while his disability application was pending.
Work requirements would take away Medicaid from caregivers and care workers.
More than 4 million family caregivers are enrolled in Medicaid for their own health insurance. Family caregivers are key to enabling older adults to remain at home instead of moving to a nursing facility, providing hundreds of billions of dollars in care without compensation. Requiring caregivers to work in paid employment or document their caregiving to maintain coverage would put many at risk of losing Medicaid. Without access to health care, both the caregivers’ own health and the well-being of their loved ones they care for would be compromised.
- About 1 in 4 family caregivers with Medicaid are older adults themselves ages 50 to 64. Though the number of younger adults becoming caregivers is growing, with 24% under age 35. Many are “sandwich generation” caregivers—caring for both children and older adults at the same time.
- Caregivers face serious challenges balancing work and care, often struggling to find jobs that accommodate their caregiving obligations. A third of women caregivers decrease their work hours, more than 20% take leaves of absence, and almost 15% retire early.
Nearly 1 in 3 direct care workers relies on Medicaid for health insurance. This essential workforce is at particular risk of becoming uninsured if Medicaid work requirements are instituted. Taking Medicaid from these workers would worsen the existing direct care workforce crisis, reducing access to home-based care for older adults and people with disabilities enrolled in Medicaid.
- Paid care workers typically earn very low wages and often work irregular schedules with varying hours and may be unable to find full-time work. This variability makes it challenging to meet the minimum hours every month. Unpredictable schedules also make tracking and reporting work more burdensome.
- Personal care aides represent the second most common occupation among Medicaid expansion enrollees without children. They are unlikely to qualify for any exemptions, increasing the likelihood they will have their Medicaid taken away when they cannot find sufficient work or get caught in the red tape.
Caregivers Don’t Have Time for Work Requirements
Joanna, age 31, lives in Sacramento and gained access to Medi-Cal, California’s Medicaid program, thanks to Medicaid expansion. For over a decade, Joanna has been an unpaid family caregiver for her grandfather, grandmother, and mother who is disabled and housing insecure. Due to her caregiving responsibilities, Joanna is unable to hold full-time employment. Medicaid work requirements would put Joanna’s health care at risk. Without being able to manage her own health, Joanna wouldn’t be able to care for her family. Joanna has seen first-hand how administrative barriers and unnecessary bureaucracy impact access to health care, as she has worked tirelessly to fill out forms and keep track of deadlines in order to be sure her family can keep their health care.
