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. Moreover, resources spent on implementing these bureaucratic hurdles will delay access to critical health, financial, and food support for everyone.
Work Requirements Would Cut Medicaid for Older Adults With Disabilities and Chronic Health Conditions
Nearly 1 in 5 Americans ages 50 to 64 get their health insurance through Medicaid. These older adults have higher rates of disability and greater health care needs and therefore may not be able to work, especially without access to health care.
- Half of adults ages 50-64 who rely on Medicaid have a disability. More than half of these older adults do not receive SSI and would be subject to work requirements. Even those who do receive SSI could get caught in the bureaucracy and may not be automatically exempt from work requirements.
- Over 7 out of 10 low-income adults ages 50-64 report having fair/poor health or chronic conditions, making it harder for them to work on a consistent basis.
Older adults also have a harder time finding work. Many experience age discrimination and increasing difficulties finding work after the COVID-19 pandemic. Among Medicaid enrollees not receiving SSI or Medicare, 53% of those ages 46 to 64 were working compared to 67% of 26 to 45 year-olds.
Work Requirements Would Take Away Medicaid From Family Caregivers
Older adults who aren’t yet Medicare eligible often take care of their parents, children, and grandchildren, and spouses or friends. Many are “sandwich generation” caregivers—caring for both children and older adults at the same time. Family caregivers of all ages are often key to enabling older adults to remain at home instead of moving to a nursing facility.
- More than 1 in 3 family caregivers are between the ages of 50 and 64 and have limited time to do other work or may not be able to find a job that accommodates their caregiving duties.
- Family caregivers are more likely to be low-income, women, and people of color and less likely to have access to health insurance through a job or a spouse.
- Over half of women caregivers with incomes of $35,000 or less spend more than 20 hours per week providing care. A third decrease their work hours, more than 20% take leaves of absence, and almost 15% retire early. Over half have a chronic condition of their own.
The Real Life Impact
Medicaid is keeping Tom alive. After working in construction his whole life, Tom, age 60, experienced a series of heart attacks. He cannot return to work with his current disabilities, and Medicaid is the only health insurance available to him. Medicaid covers his cardiologist visits and the eight medications he needs to stay alive. Tom has applied for Social Security disability benefits, but has not been approved. If Medicaid work requirements were implemented, Tom doesn’t know how he would prove that he is disabled and cannot work since his disability application is still pending. The uncertainty of whether his state would even approve an exemption adds to his stress. He knows he cannot afford the care and treatment he needs out-of-pocket.
Lisa, age 54, and her husband are happy to be able to live at home together. Medicaid makes that possible. Lisa’s husband is in stage four kidney failure and has suffered multiple strokes. Lisa used to work full time as a florist while balancing other jobs to make ends meet, but keeping a job is impossible now that she is her husband’s sole caregiver. Without Lisa, her husband likely would be forced to go into a nursing facility. Caregiving is round-the-clock work, and Lisa is exhausted from being up throughout the night. She can’t imagine more paperwork or how she could document and report the hours she spends caring for her husband. Yet, if Medicaid required her to work, that’s exactly what she would have to do to keep her coverage.
