August 2019 | Issue Brief Understanding the Intersection of Medicaid and Work: What Does the Data Say? Rachel Garfield, Robin Rudowitz, Kendal Orgera and Anthony Damico Under the Trump Administration, the Centers for Medicare and Medicaid Services (CMS) issued guidance for state Medicaid waiver proposals that would impose work requirements in Medicaid as a condition of eligibility, and several states have received approval for or are pursuing these waivers. Work requirement waivers generally require beneficiaries to verify their participation in certain activities, such as employment, job search, or job training programs, for a certain number of hours per week or verify an exemption to receive or retain Medicaid coverage. Details about the specific number of hours, approved activities, exemptions, reporting process, and populations included (e.g., expansion adults and/or low- income parents, age) vary across states. As a result of litigation challenging work requirements, three states (Arkansas, Kentucky and New Hampshire) have had such waivers set aside by the courts. 1 As of July 2019, Indiana is the only other state to have implemented a work requirement waiver. Five more states have approved waivers that are not yet implemented, and another seven states have waiver requests pending with CMS. This brief builds on previous analyses to analyze data on Medicaid enrollees and work and examine some of the policy implications of work requirements. Appendix tables provide state-level data. Key findings include the following:  Most Medicaid adults are already working; among those who are not working, most report barriers to work. Those with better health and more education are more likely to be working.  Most Medicaid adults who work are working full-time for the full year but are working in low-wage jobs in industries with low employer-sponsored insurance (ESI) offer rates. Industries and occupations with the largest number of workers covered by Medicaid often include jobs that are physically demanding such as food service or construction. Even when working, adults with Medicaid face high rates of financial and food insecurity, as they are still living in or near poverty.  Many Medicaid enrollees face barriers to work such as functional disabilities, serious medical conditions, school attendance, and care-taking responsibilities. Many Medicaid adults do not use computers, the internet or email, which could be a barrier in finding a job or complying with policies to report work or exemption status.  People who remain eligible for coverage could lose coverage as a result of reporting requirements, and work requirements may not result in increased employment or employer-based health coverage. The outcome of the pending litigation, experience of states’ implementation of approved waivers and the outcome of pending waiver requests in non-expansion states will have implications for Medicaid enrollees and for states seeking to adopt similar policies. What is the work status of Medicaid adults? Most Medicaid adults are already Figure 1 working; among those who are not The large majority of Medicaid adults are already working or report potential barriers to work. working, most report potential Work Status & Barriers to Work Among Non-Dual, Non-SSI, Nonelderly Medicaid Adults, 2017 barriers to work (Figure 1). Overall, Not Working Due to Retirement, Inability more than six in ten (63%) non-dual, Not Working to Find Work, or Other Reason Due to School non-SSI, nonelderly adults with Attendance 7% 7% Medicaid (referred to hereafter as Not Working Due to Illness Medicaid adults) are working either or Disability 11% Working Full-Time full or part-time. Even though 44% Share Working: Not Working Due 63% individuals qualifying for Medicaid on to Caregiving 12% the basis of a disability (e.g., by Working receiving SSI) and those dually Part-Time 19% eligible for Medicare are not subject Total = 23.5 million to work requirements under CMS Notes: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. Working Full- Time is based on total number of hours worked per week (at least 35 hours). Full-time workers may be simultaneously working more than one job. Source: Kaiser Family Foundation analysis of March 2018 Current Population Survey. policy and therefore were excluded from this analysis, illness or disability was a primary reason for not working among the remaining Medicaid adults. Caregiving responsibilities or school attendance were other leading reasons reported for not working. The remaining seven percent of Medicaid adults report that they are retired, unable to find work, or not working for another reason. This small group of Medicaid adult enrollees could be the primary group targeted under Medicaid work requirement policies. Those in better health and with Figure 2 more education are more likely to Work Status of Non-Dual, Non-SSI, Nonelderly be working (Figure 2). Health status Medicaid Adults by Key Demographics, 2017 is the strongest predictor of work, with Share Who Are Working Themselves: people in excellent or very good 69% 72% health thirty percentage points more 64% 62% 64% 62% 68% 64% 58% likely to be working than those in fair 54% or poor health. Education level is also 39% a strong predictor of work. Although “work readiness” encompasses a range of factors, including Excellent/ Good Fair/ < High High Some Bachelor's Northeast Midwest South West social/behavioral skills, technical Very Good Poor School School Grad College or Higher skills, “soft skills,” and others,2,3 Health Status Education Region having a high school diploma is a NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. basic requirement for many jobs. Rates of work also vary by geographic region, age, and race/ethnicity. Medicaid adults living in the South are less likely to work compared to other regions. Medicaid eligibility levels are lower in the South, so more workers would be less likely to qualify for Medicaid compared to other regions. Those middle aged (26-45) and male are more likely to work than other ages and females (Table 1). Understanding the Intersection of Medicaid and Work: What does the data say? 2 Table 1: Own Work Status of Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees, 2017 Share Who Total Worked Total 23,490,000 63% Under 26 5,450,000 61%* Age 26 - 45 11,041,000 68% 46 or older 6,998,000 57%* Male 10,377,000 69% Sex Female 13,112,000 58%* White Non-Hispanic 10,939,000 63% Black Non-Hispanic 3,947,000 59%* Hispanic 6,245,000 64% Race/Ethnicity Asian, Native Hawaiian, or Pacific Islander 1,693,000 61% American Indian or Alaska Native 297,000 58% Multiple Races 369,000 71%* Less than High School 4,162,000 54%* High School Graduate 8,319,000 62%* Education Some College 7,077,000 64%* Bachelor's Degree or Higher 3,931,000 72% Northeast 5,231,000 62% Geographic Midwest 4,762,000 68%* Region South 5,906,000 58%* West 7,591,000 64% Non-Metro^ 3,347,000 64% Metro Status Metro 20,143,000 63% One Parent with Children 2,166,000 76%* Two Parents with Children 4,654,000 69% Family Type Multi-generational 1,652,000 57%* Married Adults 11,598,000 58%* Other 3,418,000 63%* Multiple Full-Time Workers in Family 4,917,000 88% Family Work One Full-Time Worker in Family 10,617,000 72%* Status Only Part-Time Workers in Family 3,391,000 82%* No Workers in Family 4,565,000 0%* Excellent/Very Good 12,037,000 69% Self-Reported Good 7,562,000 64%* Health Fair/Poor 3,890,000 39%* NOTE: * indicates statistically significant difference from italicized reference group at p<0.05 level. ^ Non-Metro includes people in not-identified areas. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 3 What do we know about Medicaid adults who are working? Most Medicaid adults who work are Figure 3 working full-time for the full year. Share of Working Non-Dual, Non-SSI, Nonelderly Medicaid Adults Working Full-Time/Part-Time and Full-Year/Part-Year, Among Medicaid adults who work, 2017 the majority (53%) worked full-time Reasons for Working Part-Time (at least 35 hours per week) for the Full-Time 6% Child Care Problems Part-Year 8% Could Only Find Part-Time Work entire year (at least 50 weeks) (Table 17% 9% Health/Medical Limitations Part-Time 4 2). Full-time work of 35 hours or Full-Year 14% Work Week < 35 Hours 15% more per week may be from more 15% Slack Work/ Business Conditions than one job (other data show that Full-Time Part-Time 15% Other Family/ Personal Obligations Full Year Part-Year nearly one in ten Medicaid workers 53% 14% 16% School/Training have more than one job).5 Among 17% Other Reason Medicaid adults who work part-time (30% of all workers), many cite Total = 14.8 million Total = 4.4 million reasons such as school or training NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. Those not in universe are included in the full-time/part-time pie, but excluded in the reasons for working part-time figure due to question timing. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. (16%) or shorter work weeks (less than 35 hours per week) (14%) as the reason they work part-time versus full-time. Other major reasons for part-time work are other family or personal obligations (15%) or slack work/business conditions (15%). Inability to find full-time work, childcare problems, health/medical limitations, and other reasons are the remaining grounds for working part-time, which together account for one-third of part-time Medicaid workers (Figure 3). Medicaid workers have low rates of absenteeism: on average, they report missing five days of work in the previous 12 months due to illness or injury. 6 Table 2: Characteristics of Working Non-Dual, Non-SSI, Nonelderly Adult (19-64) Medicaid Enrollees, 2017 Total 14,754,000 Full-Time^ 70% Full-Time, Full-Year 53% Full-Time, Part-Year 17% Work Status Part-Time 30% Part-Time, Full-Year 15% Part-Time, Part-Year 14% 1-12 weeks 7% 13-25 weeks 7% Number of Weeks Worked During the Year 26-38 weeks 9% 39-51 weeks 12% 52 weeks 66% < 50 employees 41% Firm Size 50 - 99 employees 7% 100+ employees 52% ^ Full-Time is based on total number of hours worked per week (at least 35 hours). Full-time workers may be simultaneously working more than one-job. Numbers may not sum due to rounding. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 4 Adults who work full-time for the Figure 4 full year may still be eligible for Annual Earnings at Minimum Wage Compared to Medicaid in expansion states Annual Poverty Guidelines for a Family of Three, 2019 because they are working low- Minimum Wage and Poverty Level Guidelines for a Family of Three wage jobs (Figure 4). An individual $29,435 working full-time (35 hours/week) for the full year at the federal minimum $21,330 7 wage ($7.25 per hour) earns an Federal Minimum annual salary of just over $12,688 a Wage Full-Time $12,688 (35 Hours/Week) year, just below the federal poverty Federal Minimum Wage Part-Time $7,250 $8,532 level (FPL) for an individual in 2019. (20 Hours/Week) $5,546 This income is below the Medicaid $3,839 eligibility limit of 138% FPL for nearly 18% FPL 26% FPL 40%FPL 100% FPL 138% FPL all nonelderly adults in expansion NOTE: FPL is Federal Poverty Level. All FPLs are at the individual level. SOURCE: HHS Poverty Guidelines for 2019, https://aspe.hhs.gov/poverty-guidelines. Federal minimum wage, https://www.dol.gov/general/topic/wages/minimumwage. states ($17,236/year for an individual or $29,435 for a family of three in 2019). Medicaid adults who work full-time or part-time in non-expansion states could become ineligible for Medicaid, where median eligibility limit for parents is 40% FPL ($8,532/year for a family of three), and childless adults are not eligible (except in Wisconsin). Eligibility is much lower in many non-expansion states, including Alabama (18% FPL) and Mississippi (26% FPL), 8 two states with pending work requirement waivers. Since individuals with incomes below poverty are not eligible for subsidies for coverage through ACA Marketplaces, working adults in non-expansion states fall into a coverage gap without access to affordable health insurance through their job, Medicaid, or the Marketplace.9 Many Medicaid adults who work Figure 5 are employed by small firms and in Work Characteristics of Non-Dual, Non-SSI, industries that have low employer- Nonelderly Medicaid Adults, 2017 sponsored insurance (ESI) offer By Firm Size By Industry rates. More than four in ten Medicaid Manufacturing workers are employed in firms with 14% fewer than 50 employees, which are < 50 Professional/ Agriculture/ Workers not subject to ACA penalties for not 100+ Workers 41% Public Administration Services 47% 52% 19% offering affordable health coverage (Figure 5). Many Medicaid workers 50-99 Education/ are employed in industries with Workers 7% Health 20% historically low ESI offer rates, such Total = 14.8 million as the agriculture and service Notes: Data may not sum to 100% due to rounding. Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. Industry classifications: Agriculture/Services includes agriculture, construction, leisure and hospitality services, wholesale and retail trade. Education/Health includes education and health services. Professional/Public Administration includes finance, industries. Only about four in ten professional and business services, information, and public administration. Manufacturing includes mining, manufacturing, and transportation and utilities. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. (38%) Medicaid workers have an offer of ESI, and this coverage may not meet affordability requirements under the ACA. 10 In addition, many Medicaid workers report limited fringe benefits: only 26% of Medicaid workers have paid sick time Understanding the Intersection of Medicaid and Work: What does the data say? 5 at their job.11 Only 8% of Medicaid workers are members of a union, 12 which generally use collective bargaining to negotiate higher wages or benefits for members. Many Medicaid workers are employed in jobs that are physically demanding. A closer look by specific industry shows that more than a third of working Medicaid adults are employed in ten industries, with one in 10 enrollees working in restaurants or food services (Figure 6). Such jobs typically require physical tasks such as standing, walking, lifting, and carrying. The next largest group of Medicaid workers are employed in the construction industry, which also involves physical labor. When looking at specific occupations, Medicaid workers are largely employed in retail service jobs or jobs that can be physically demanding, such as nursing or personal care aide, cook or waiter/waitress, and janitor or housekeeping. Other top occupations among Medicaid workers include: cashier, salesperson, drivers, or customer service representative (Figure 7). Figure 6 Industries with Largest Number of Workers Covered by Medicaid, 2017 Industry Number of Adult Workers with Medicaid Restaurant and food services 1,467,000 Construction 1,078,000 Elementary and secondary schools 553,000 Hospitals 408,000 Home health care services 313,000 Services to buildings and dwellings 303,000 Grocery stores 291,000 Department stores and discount stores 260,000 Nursing care facilities 216,000 Landscaping services 201,000 Total for Listed Industries (35% of adult 5,090,000 Medicaid enrollees who are workers) NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Figure 7 Occupations with Largest Number of Workers Covered by Medicaid, 2017 Occupation Number of Workers with Medicaid Cashiers 590,000 Nursing, Psychiatric, and Home Health Aides 401,000 Retail Salespersons 375,000 Personal Care Aides 357,000 Driver/Sales Workers and Truck Drivers 342,000 Cooks 335,000 Waiters and Waitresses 330,000 Maids and Housekeeping Cleaners 328,000 Janitors and Building Cleaners 321,000 Customer Service Representatives 263,000 NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 6 Even when working, adults with Figure 8 Medicaid face high rates of Financial Insecurity of Non-Dual, Non-SSI, Working and financial and food insecurity, as Non-Working, Nonelderly Medicaid Adults, 2017 they are still living in or near Share Very or Moderately Worried They Will Not Have Enough Money For: poverty. Half report that they are very or moderately worried that they Medicaid Workers Medicaid Non-Workers will not have enough money to pay 56% 55% 61% 57% 51% 51% normal monthly bills, and more than 45% 42% four in ten say they are very or moderately worried about having enough money for housing (Figure 8), rates similar to non-working adults Normal Rent, Mortgage, Maintain Standard Retirement with Medicaid. While income gained Monthly Bills or Housing of Living from work can improve financial NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. Differences between workers and non-workers not significant at p<0.1 level. SOURCE: Kaiser Family Foundation analysis of 2017 National Health Interview Survey. security, this pattern shows that low- income workers still face substantial Figure 9 insecurity given the nature of their Food Insecurity of Non-Dual, Non-SSI, Working and Non-Working, Nonelderly Medicaid Adults, 2017 jobs. Additionally, people who meet Medicaid work requirements through Share Who Say That Due to Lack of Money They or Their Family: participating in volunteer activities will Medicaid Workers Medicaid Non-Workers not gain income to improve their financial security. More than a quarter 38% 36%* 34% (28%) of working and 36% of non- 28% 30%* 29%* 29%* 27%* 23% working Medicaid adults say they 20% 20% 19% 17%* sometimes or often worry that food 11% will run out, and high shares also report that they have experienced Worry Food Will Run Out^ Food Did Not Last^ Cannot Afford to Eat Balanced Cut Meal Size or Skip Meal Hungry But Did Not Eat Lost Weight Did Not Eat for Entire Day Meals^ problems such as food not lasting * Indicates statistically significant difference from Medicaid Workers at the p<0.05 level. NOTE: ^ Sometimes or Often true. Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not before funds were available to buy dual eligible. SOURCE: Kaiser Family Foundation analysis of 2017 National Health Interview Survey. more, having to cut meal size or skip meals, not eating due to lack of money, losing weight, or not eating for an entire day (Figure 9). While food assistance programs are available to low-income people, these programs do not reach everyone who faces food insecurity; among all Medicaid adults, only 29% live in a household that receives food assistance, and more than a quarter (26%) of working Medicaid adults live in a household that receive food assistance.13 Understanding the Intersection of Medicaid and Work: What does the data say? 7 What barriers to work and reporting requirements do Medicaid adults face? Work requirement waivers generally require beneficiaries to verify their participation in certain activities, such as employment, job search, or job training programs, for a certain number of hours per week or verify an exemption to receive or retain Medicaid coverage. Exemptions to work activities may include medical frailty, attending school, care-giving responsibilities and others. This section highlights barriers that enrollees may face in working or reporting work or exemptions to work. There are high rates of functional Figure 10 disability and serious medical Physical Limitations of Non-Dual, Non-SSI, Nonelderly conditions among Medicaid adults, Medicaid Adults by Work Status, 2017 4% especially among those not Difficulty Using Hands or Fingers 13% working. More than a third (34%) of Difficulty Lifting or N/A those not working live with multiple Carrying 10 Pounds 14% chronic medical conditions such as Pain Limits Life or N/A Work Every Day* 16% hypertension, high cholesterol, Medicaid Workers Medicaid Non-Workers 5% arthritis, or heart disease,14 and half Difficulty Pushing or Pulling Large Objects 19% (51%) have any functional limitation, Difficulty Stooping, 10% Kneeling, or Bending including mobility, physical, or 23% emotional limitations.15 Many Difficulty Sitting or Standing for Two Hours 10% 27% Medicaid adults who are not working NOTE: N/A indicates insufficient data to report estimates. Includes nonelderly adults (age 19-64) with Medicaid coverage who do not receive Supplemental Security Income (SSI) and are not dual eligible. * Reference period is past 6 months. All differences between workers and non- report physical health problems that workers, except for those where data is insufficient, are significant at p<0.05 level. SOURCE: Kaiser Family Foundation analysis of 2017 National Health Interview Survey. could limit their ability to work, such as daily, activity-limiting pain, difficulty standing or sitting for two hours, difficulty stooping, bending, or kneeling, using hands or fingers, or carrying 10 pounds, compared to Medicaid workers (Figure 10). Many have mobility restrictions that can be severe and may limit employment options: among those not working, nearly a fifth (18%) report difficulty walking 100 yards, 23% report difficulty walking up or down 12 steps, and 7% report the use of equipment or help to get around. 16 Mental health conditions can also impede an individual’s ability to work. More than a third (35%) of non-working Medicaid adults report depression17 and more than one in ten (12%) report difficulty participating in social activities. 18 Understanding the Intersection of Medicaid and Work: What does the data say? 8 Going to school or care-taking responsibilities are other reported barriers to obtaining paying work. Even among those unlikely to meet medical frailty exemptions (the so-called “able bodied”), many could be exempt from complying with a work requirement policy for other reasons. Among those in excellent or very good health, nearly three fourths (74%) of those not working say it is because they are in school (33%) or are a caretaker (41%) (Figure 11). Figure 11 Reason for Not Working Among Non-Dual, Non-SSI, Nonelderly Medicaid Adults, by Health Status, 2017 2% 5% 4% 2% Other 6% 8% 3% 14% 13% Could Not 33% 8% Find Work Attending 37% School Caretaking 41% 70% 12% Retired 9% 25% Ill or Disabled 7% Excellent/ Good Fair/Poor Very Good Health Health Health Total Number of 3.7M 2.7M 2.4M Non-Workers NOTE: Totals may not sum to 100% due to rounding. Among those not working during the prior year. Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Many Medicaid adults do not use computers, the internet or email, which could be a barrier in finding a job and in complying with work reporting requirements. More than a quarter (26%) of Medicaid adults report that they never use a computer, 19 25% do not use the internet,20 and 40% do not use email21 (Figure 12), which may pose a barrier to both gaining a job and complying with reporting requirements under state waivers. For example, when it was in effect, Arkansas’ waiver required beneficiaries to set up an on-line account and use this account to report work activities and exemptions (reporting by phone was added as an option in December 2018). Figure 12 Computer Use of Non-Dual, Non-SSI, Nonelderly Medicaid Adults by Work Status, 2017 Share Who Say They: All Medicaid Adults Medicaid Workers Medicaid Non-Workers 45% 40% 34% 31% 30% 26% 25% 23% 20% Never Use Computer Do Not Use Internet Do Not Use Email NOTE: Includes nonelderly adults (age 19-64) with Medicaid coverage who do not receive Supplemental Security Income (SSI) and are not dual eligible. All differences between workers and non-workers significantly different at p<0.05 level. SOURCE: Kaiser Family Foundation analysis of 2017 National Health Interview Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 9 Research shows that enrollees Figure 13 report a range of barriers to Barriers to Work and Reporting Requirements complying with work and complex Faced by AR Works Enrollees reporting requirements. Interviews Physically demanding with enrollees in Arkansas show that job Needs 1:1 Unstable/ fluctuating enrollees face many barriers in help with computers work hours complying with both work and reporting requirements (Figure 13).22 Unreliable Barriers to Chronic physical internet Work and health Another report examining state data access Reporting condition shows that measures to provide Mental safeguards intended to protect Homeless health condition coverage for people with disabilities Lack of transportation and others who should not have been subject to the requirements are SOURCE: Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees, Kaiser Family Foundation, December 2018. https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of-enrollees/ complex and hard to use.23 This experience is consistent with findings that TANF work requirements adversely affected people with disabilities who likely were eligible for an exemption based on a disability but did not obtain one. 24 What are the potential implications of Medicaid work and reporting requirements? People who remain eligible for coverage could lose coverage as a result of work and reporting requirements. In Arkansas, over 18,000 people lost coverage when the work and reporting requirements were in place from August to December 2018. A small share of those who lost coverage reapplied and regained coverage when they were able to do so at the beginning of 2019. An earlier KFF analysis of potential nationwide reductions in Medicaid coverage if all states implemented work requirements estimated that most disenrollment would be among individuals who would remain eligible but lose coverage due to new administrative burdens or red tape, and only a minority would lose eligibility due to not meeting new work requirements. Updated analysis shows that estimated disenrollment ranges from 1.5 million to 4.1 million under a range of coverage loss assumptions considered (assumptions were based in past experience with reporting and work requirement policies). Establishing nationwide work requirements was included in the Administration’s proposed budget for FY 2020. 25 Understanding the Intersection of Medicaid and Work: What does the data say? 10 Work requirements may not result in increased employment or employer-based health coverage. Arkansas enrollees reported that new work requirements did not provide an additional incentive to work, beyond economic pressures to pay for food and other bills.26 Another study found that work requirements in Arkansas did result in significant changes in employment.27 Among individuals who may find work, low- income jobs are not likely to come with employer-sponsored insurance (ESI). ESI offer rates are low among poor (below 100% FPL) and low-income (between 100 and 250% FPL) workers who work full-time (25% and 42%, respectively). Very few part-time workers, especially those with low-incomes, receive an employer-sponsored offer of health benefits (Figure 14). Figure 14 Share of Working Medicaid Adults Offered Employer Sponsored Coverage, by Income & Work Status, 2017 <100% FPL 100-<250% FPL 250-<400% FPL 400%+ FPL All Incomes 61% 56% 48% 46% 41% 42% 38% 36% 30% 25% 21% 19% 19% 17% 12% All Workers Full-Time Workers Part-Time Workers NOTE: Includes nonelderly adults (age 19-64) who do not receive Supplemental Security Income (SSI) and are not dual eligible. FPL= federal poverty level. The U.S. Census Bureau's Official Poverty Threshold for a family of two nonelderly adults and one child was $19,730 in 2017. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Loss of coverage could have negative implications for a person’s ability to work and can also increase uncompensated care for providers. Enrollees in Arkansas noted that Medicaid coverage enabled them to work by covering medications and services needed to manage mental health, asthma, gastrointestinal conditions, and other chronic health conditions. Without coverage, these conditions could worsen and interfere with enrollees’ ability to work or their ability to look for work and also could result in emergency room visits or preventable hospitalizations. In addition, providers anticipated that coverage losses tied to work requirements could result in increased uncompensated care for providers. Understanding the Intersection of Medicaid and Work: What does the data say? 11 Looking Ahead As litigation about Medicaid work and reporting requirements in several states moves ahead in the courts, the Centers for Medicare and Medicaid Services (CMS) and some other states continue to pursue these waivers. An appeal currently is underway in the DC Circuit after a federal trial court stopped implementation of Arkansas’ work and reporting requirements in March 2019, and prohibited Kentucky’s waiver from going into effect in April as planned. On July 29, 2019, the court set aside the Granite Advantage Health Care Program demonstration, approved by CMS on Nov. 30, 2018. Implementation of the work requirement was stopped unless and until HHS issues a new approval that passes legal muster or prevails on appeal. Previously, on July 8, 2019, New Hampshire enacted legislation that allowed for the suspension of the work requirement’s implementation up to but not after July 1, 2021, and suspended the work requirement through Sept. 30, 2019. As of July 2019, Indiana is the only other state to have implemented a work requirement waiver; six more states have approved waivers that are not yet implemented. Arizona has submitted a request to CMS to delay implementation of its work requirement beyond the January 2020 date.28 Another seven states have waiver requests pending with CMS, including states that have not adopted the expansion. The outcome of the pending litigation, experience of states’ implementation of approved waivers and the outcome of pending waiver requests in non-expansion states will have implications for Medicaid enrollees and for states seeking to adopt similar policies. Understanding the Intersection of Medicaid and Work: What does the data say? 12 Appendix Appendix Table 1: Family and Own Work Status of Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees, 2017 Total # Non-SSI, Family Work Status Own Work Status Non-Dual, No Full-Time Part-Time Nonelderly Adult Worker Worker Worker in Not Working Working Medicaid Enrollees in Family in Family Family Working Full-Time Part-Time US TOTAL 23,490,000 19% 66% 14% 37% 44% 19% Alabama 237,000 24% 67% 10% 46% 40% 14% Alaska 59,000 21% 62% 17% 40% 40% 21% Arizona 610,000 14% 70% 16% 34% 46% 20% Arkansas 196,000 25% 63% 12% 46% 39% 16% California 4,623,000 14% 72% 14% 36% 45% 19% Colorado 378,000 22% 68% NA 35% 46% 19% Connecticut 370,000 16% 68% NA 33% 48% 19% Delaware 75,000 24% 61% 16% 44% 38% 18% District of Columbia 75,000 27% 56% 17% 38% 41% 21% Florida 1,015,000 27% 65% 8% 44% 45% 11% Georgia 403,000 25% 65% NA 42% 46% 13% Hawaii 77,000 23% 63% 14% 50% 33% 16% Idaho 73,000 26% 65% 9% 43% 45% 13% Illinois 814,000 17% 69% 14% 32% 49% 19% Indiana 523,000 15% 71% 14% 28% 51% 21% Iowa 213,000 NA 69% 18% 22% 55% 23% Kansas 88,000 NA 58% NA 37% 40% NA Kentucky 421,000 24% 60% 16% 35% 47% 18% Louisiana 378,000 27% 52% 21% 44% 33% 24% Maine 92,000 20% 54% 26% 32% 38% 30% Maryland 405,000 14% 78% NA 30% 59% 11% Massachusetts 790,000 20% 64% 15% 33% 44% 23% Michigan 922,000 19% 66% 15% 35% 43% 23% Minnesota 525,000 13% 62% 25% 22% 46% 33% Mississippi 168,000 29% 58% 13% 45% 38% 17% Missouri 264,000 25% 56% 19% 42% 39% 19% Montana 86,000 15% 67% 18% 27% 49% 24% Nebraska 50,000 NA 67% 20% 31% 42% 27% Nevada 179,000 26% 61% 13% 41% 44% 16% New Hampshire 52,000 25% 56% NA 35% 35% 30% New Jersey 616,000 17% 66% 17% 41% 39% 19% New Mexico 285,000 17% 68% 15% 35% 49% 16% New York 2,218,000 19% 67% 14% 39% 44% 17% North Carolina 469,000 30% 54% 17% 47% 35% 18% North Dakota 27,000 25% 60% NA 44% 37% 20% Ohio 951,000 22% 60% 18% 37% 40% 23% Oklahoma 165,000 16% 69% NA 34% 49% 17% Oregon 406,000 13% 76% 11% 29% 56% 15% Pennsylvania 977,000 25% 59% 16% 40% 40% 20% Rhode Island 69,000 26% 64% NA 41% 39% 21% South Carolina 299,000 22% 66% 12% 39% 47% 15% South Dakota 27,000 25% 54% 21% 49% 30% NA Tennessee 391,000 23% 63% 14% 41% 43% 16% Texas 783,000 25% 65% 10% 50% 38% 12% Utah 52,000 NA 67% 22% 30% 42% 27% Vermont 47,000 21% 64% 14% 35% 48% 18% Virginia 233,000 17% 69% NA 31% 50% 19% Washington 744,000 23% 66% 11% 37% 45% 18% West Virginia 194,000 33% 53% 14% 52% 30% 17% Wisconsin 359,000 15% 65% 21% 26% 47% 27% Wyoming 19,000 24% 61% 15% 39% 44% 17% NOTES: NA= estimate does not meet minimum standard for statistical reliability. Full-Time is based on total number of hours worked per week (at least 35 hours). Full-time workers may be simultaneously working more than one-job. Note that total number of non-elderly, non-SSI adults from survey data may be lower than state administrative data. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 13 Appendix Table 2: Reason for Not Working Among Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees, 2017 Working Ill or Disabled Caretaking Attending School Other Reason US TOTAL 63% 11% 12% 7% 7% Alabama 54% 15% 14% NA 9% Alaska 60% NA 12% 10% 13% Arizona 66% 8% 16% 4% 6% Arkansas 54% 18% 14% NA 9% California 64% 8% 14% 8% 6% Colorado 65% NA 13% NA NA Connecticut 67% 11% 12% 6% NA Delaware 56% 18% NA 9% 10% District of Columbia 62% 14% 8% NA 12% Florida 56% 11% 10% 15% 8% Georgia 58% 16% 10% NA NA Hawaii 50% 10% 20% NA NA Idaho 57% NA 11% NA NA Illinois 68% 9% 12% NA 8% Indiana 72% 16% NA NA NA Iowa 78% NA NA NA NA Kansas 63% NA NA NA NA Kentucky 65% NA 13% NA NA Louisiana 56% 18% 14% 4% 7% Maine 68% NA 11% NA NA Maryland 70% NA 11% NA 9% Massachusetts 67% 10% 6% 12% 4% Michigan 65% 11% 13% 5% 7% Minnesota 78% 9% NA NA 8% Mississippi 55% 20% 11% NA 8% Missouri 58% 23% 8% 6% NA Montana 73% 8% 10% NA NA Nebraska 69% NA 8% NA NA Nevada 59% 11% 17% NA NA New Hampshire 65% 15% NA NA NA New Jersey 59% 12% 9% 9% 10% New Mexico 65% 7% 13% 8% 6% New York 61% 8% 14% 9% 9% North Carolina 53% 13% 14% 12% 8% North Dakota 56% NA 18% NA NA Ohio 63% 14% 12% 4% 8% Oklahoma 66% NA 15% NA NA Oregon 71% NA 14% NA NA Pennsylvania 60% 16% 10% 7% 8% Rhode Island 59% 18% 12% NA NA South Carolina 61% 17% 11% NA NA South Dakota 51% NA 23% NA NA Tennessee 59% 16% 7% 9% NA Texas 50% 15% 18% 11% 6% Utah 70% NA NA NA NA Vermont 65% 9% 13% NA NA Virginia 69% 15% NA NA NA Washington 63% 12% 9% 6% 10% West Virginia 48% 19% 16% 9% 9% Wisconsin 74% 10% 9% NA NA Wyoming 61% NA 23% NA NA NOTES: NA= estimate does not meet minimum standard for statistical reliability. Other reason includes retired, could not find work, and other reasons. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 14 Appendix Table 3: Characteristics of Working Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees, 2017 Firm Size (# Employees) Industry Agriculture/ Education/ Professional/ <50 50-99 100+ Services Health Public Admin Manufacturing Top Industry US TOTAL 41% 7% 52% 47% 20% 19% 14% Restaurants/Food Service Alabama 35% NA 61% 43% 19% 18% NA Restaurants/Food Service Alaska 58% NA 39% 49% 21% 16% 13% Construction Arizona 42% 11% 47% 50% 21% 20% 9% Construction Arkansas 33% NA 60% 46% 19% 10% 25% Restaurants/Food Service California 46% 8% 46% 48% 17% 21% 14% Restaurants/Food Service Colorado 44% NA 50% 43% 19% 23% NA NA Connecticut 37% NA 57% 41% 24% 19% 16% Restaurants/Food Service Delaware 35% NA 58% 48% 20% NA NA NA District of Columbia 33% 7% 60% 48% 17% 26% 8% Restaurants/Food Service Florida 41% 7% 52% 50% 18% 21% 11% Restaurants/Food Service Georgia 45% NA 45% 51% NA 18% 17% NA Hawaii 53% NA 42% 62% 17% 16% NA NA Idaho 55% NA 35% 49% NA NA 25% Construction Illinois 40% 8% 52% 43% 16% 20% 22% Restaurants/Food Service Indiana 38% NA 56% 45% 21% 14% 20% Restaurants/Food Service Iowa 39% NA 54% 39% 28% 20% NA NA Kansas NA NA 71% 41% NA NA NA NA Kentucky 40% 9% 51% 56% 18% 15% NA Restaurants/Food Service Louisiana 42% NA 53% 50% 25% 17% 9% Restaurants/Food Service Maine 56% NA 38% 59% NA NA NA NA Maryland 39% NA 54% 45% 15% 33% NA Restaurants/Food Service Massachusetts 37% 9% 53% 40% 24% 21% 15% Restaurants/Food Service Michigan 28% 10% 62% 47% 21% 13% 19% Restaurants/Food Service Minnesota 39% 7% 54% 48% 25% 12% NA Restaurants/Food Service Mississippi 38% NA 59% 56% 26% NA NA Restaurants/Food Service Missouri 36% NA 60% 42% 21% NA 21% NA Montana 50% 6% 43% 53% 15% 20% 12% Restaurants/Food Service Nebraska 50% NA 44% 49% NA 29% NA NA Nevada 34% NA 62% 50% NA 31% NA NA New Hampshire 32% NA 62% 44% 26% NA NA NA New Jersey 41% NA 49% 43% 25% 21% 11% Restaurants/Food Service New Mexico 51% 6% 43% 51% 25% 13% 11% Construction New York 38% 8% 53% 46% 23% 17% 14% Restaurants/Food Service North Carolina 38% NA 58% 51% 17% 12% 19% Restaurants/Food Service North Dakota 35% NA 56% 51% 26% NA NA NA Ohio 35% 6% 59% 46% 20% 20% 14% Restaurants/Food Service Oklahoma 44% NA 46% 48% 17% NA 25% NA Oregon 49% NA 45% 51% 17% 20% 11% Restaurants/Food Service Pennsylvania 45% 7% 48% 41% 28% 18% 14% Restaurants/Food Service Rhode Island 34% NA 58% 39% 23% NA 19% NA South Carolina 38% NA 61% 43% 20% 26% 12% NA South Dakota 54% NA NA 70% NA NA NA Restaurants/Food Service Tennessee 40% NA 52% 46% 22% 23% NA NA Texas 39% NA 52% 41% 19% 21% 20% Construction Utah 38% NA 53% 50% NA 23% NA NA Vermont 45% NA 48% 53% 27% NA NA NA Virginia 26% NA 69% 52% NA 23% NA NA Washington 44% NA 53% 56% 17% 18% 9% Restaurants/Food Service West Virginia 35% 8% 58% 49% 27% 13% 11% Restaurants/Food Service Wisconsin 42% NA 50% 33% 24% 19% 24% NA Wyoming 45% 17% 38% 41% 21% NA NA NA NOTES: Totals may not sum to 100% due to rounding. NA= estimate does not meet minimum standard for statistical reliability. Agriculture/Services includes agriculture, construction, leisure and hospitality services, wholesale and retail trade. Education/Health includes education and health services. Professional/Public Administration includes finance, professional and business services, information, and public administration. Manufacturing includes mining, manufacturing, and transportation and utilities. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 15 Appendix Table 4a: Share Working Among Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees by Sociodemographic Characteristics, 2017 Share Working Within Share Working Share Working Within Each Age Group Within Each Sex Each Race/Ethnicity Group White, Black, Other Age Age Age Women Men Non- Non- Hispanic Non- 19-25 26-45 46+ Hispanic Hispanic Hispanic US TOTAL 61% 68% 57% 58% 69% 63% 59% 64% 62% Alabama 63% 54% 48% 47% 65% 47% 54% 82% 76% Alaska 65% 66% 43% 57% 64% 63% NA 45% 62% Arizona 65% 73% 54% 59% 75% 63% 59% 69% NA Arkansas 67% 57% 41% 50% 62% 48% 58% 77% 60% California 61% 66% 61% 56% 73% 66% 59% 64% 62% Colorado 68% 78% 46% 60% 70% 62% 57% 70% 82% Connecticut 51% 68% 73% 60% 76% 73% 77% 61% NA Delaware 60% 67% 42% 54% 58% 43% 63% 65% 73% District of Columbia 65% 64% 55% 62% 62% 78% 57% 71% 90% Florida 35% 70% 57% 57% 55% 44% 62% 61% 80% Georgia 52% 66% 46% 53% 66% 65% 48% 77% NA Hawaii 61% 41% 52% 51% 48% 54% NA 51% 48% Idaho 66% 65% 43% 49% 66% 59% NA 50% 61% Illinois 72% 71% 61% 58% 78% 72% 54% 68% 73% Indiana 75% 76% 63% 68% 77% 75% 54% 76% 79% Iowa 72% 81% 77% 78% 76% 78% NA 77% NA Kansas 81% 65% 32% 66% 58% 60% 76% 87% NA Kentucky 66% 70% 57% 58% 73% 63% 64% 89% NA Louisiana 61% 62% 42% 54% 61% 55% 57% 51% 70% Maine 83% 64% 65% 61% 77% 65% NA NA 88% Maryland 58% 74% 71% 62% 79% 72% 68% 75% 57% Massachusetts 48% 74% 70% 68% 67% 66% 73% 68% 62% Michigan 77% 68% 49% 57% 74% 71% 61% 51% 47% Minnesota 91% 82% 65% 77% 80% 79% 91% 79% 65% Mississippi 59% 56% 52% 52% 61% 57% 54% NA NA Missouri 47% 66% 53% 60% 56% 58% 60% NA NA Montana 84% 80% 53% 68% 78% 72% NA 80% 77% Nebraska 76% 65% 65% 60% 81% 72% 72% 76% NA Nevada 57% 64% 52% 48% 70% 61% NA 61% NA New Hampshire 78% 70% 40% 62% 68% 62% NA 87% 66% New Jersey 50% 70% 48% 55% 63% 58% 50% 64% 63% New Mexico 63% 68% 62% 60% 71% 66% NA 67% 56% New York 53% 66% 58% 52% 70% 59% 56% 66% 63% North Carolina 58% 51% 47% 51% 56% 52% 50% 56% 64% North Dakota 70% 47% 62% 52% 63% 62% 63% 72% NA Ohio 72% 67% 51% 64% 63% 64% 56% 76% 81% Oklahoma 59% 72% 54% 61% 75% 70% NA 72% 58% Oregon 73% 69% 75% 62% 82% 70% NA 81% 65% Pennsylvania 64% 65% 50% 58% 62% 58% 60% 64% 65% Rhode Island 86% 68% 36% 60% 58% 60% 55% 59% 80% South Carolina 57% 68% 50% 54% 71% 57% 65% 86% 72% South Dakota NA 58% 54% 44% 70% 60% NA 53% 35% Tennessee 58% 67% 43% 64% 51% 54% 63% 78% 82% Texas 40% 56% 48% 46% 57% 51% 51% 49% NA Utah 87% 60% 74% 77% 60% 67% NA 71% NA Vermont 74% 72% 50% 60% 73% 66% 73% NA 73% Virginia 82% 71% 58% 63% 80% 76% 63% 64% 64% Washington 66% 70% 49% 58% 68% 60% 71% 69% 62% West Virginia 40% 53% 45% 43% 54% 47% 61% NA NA Wisconsin 60% 86% 63% 75% 72% 76% 79% 61% 60% Wyoming 64% 53% 81% 53% 71% 59% NA 69% 59% NOTES: NA= estimate does not meet minimum standard for statistical reliability. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 16 Appendix Table 4b: Share Working Among Non-Dual, Non-SSI, Nonelderly Adult Medicaid Enrollees by Sociodemographic Characteristics, 2017 Share Working Within Each Health Share Working Within Each Education Level Status Group High < High Some BA or Excellent/ School Fair/Poor Good School College Higher Very Good Grad US TOTAL 54% 62% 64% 72% 39% 64% 69% Alabama NA 52% 64% 60% NA 48% 63% Alaska 42% 62% 68% 60% 54% 51% 67% Arizona 57% 67% 76% 69% 38% 73% 69% Arkansas 44% 53% 60% 63% 23% 64% 69% California 60% 61% 65% 71% 41% 66% 68% Colorado 57% 53% 68% 77% NA 58% 75% Connecticut 57% 65% 68% 75% 41% 72% 71% Delaware 38% 50% 71% 82% NA 57% 62% District of Columbia 46% 60% 63% 79% 45% 51% 75% Florida 43% 58% 52% 72% 21% 62% 61% Georgia NA 55% 62% 75% NA 53% 72% Hawaii 48% 47% 50% 56% 39% 39% 62% Idaho 54% 64% 40% 80% NA 60% 67% Illinois 54% 69% 67% 74% NA 77% 70% Indiana 51% 75% 73% 86% 42% 67% 88% Iowa 68% 77% 82% 77% NA 70% 86% Kansas 59% 62% 76% NA NA 52% 72% Kentucky 58% 59% 63% 97% 42% 72% 76% Louisiana 43% 57% 58% 78% 33% 63% 64% Maine NA 67% 66% 78% 47% 58% 84% Maryland 81% 77% 58% 79% 70% 60% 76% Massachusetts 61% 72% 62% 68% 51% 76% 68% Michigan 54% 66% 67% 67% 43% 74% 69% Minnesota 67% 75% 81% 88% NA 78% 89% Mississippi 37% 53% 60% 77% 48% 62% 53% Missouri NA 57% 58% 81% 29% 69% 73% Montana NA 67% 74% 89% 39% 62% 80% Nebraska 57% 78% 66% 83% 71% 69% 68% Nevada 42% 57% 59% 88% NA 62% 68% New Hampshire NA 63% 81% NA 51% 84% 60% New Jersey NA 62% 57% 67% 42% 55% 66% New Mexico 58% 66% 64% 74% 57% 73% 63% New York 52% 62% 61% 64% 50% 58% 66% North Carolina 34% 61% 54% 60% NA 52% 60% North Dakota 44% 56% 63% 58% 41% 48% 66% Ohio 44% 61% 70% 70% 43% 63% 72% Oklahoma 60% 66% 67% 77% 56% 64% 71% Oregon 76% 66% 68% 81% 46% 67% 83% Pennsylvania 49% 57% 57% 82% 35% 65% 68% Rhode Island 44% 56% 62% 84% NA 57% 73% South Carolina 40% 61% 69% 68% NA 61% 67% South Dakota NA 45% 58% 56% 39% 35% 62% Tennessee 53% 56% 58% 74% NA 71% 72% Texas 47% 48% 47% 70% 31% 63% 50% Utah NA NA 82% 94% NA NA 89% Vermont NA 62% 65% 81% 48% 56% 75% Virginia 63% 65% 66% NA NA 76% 81% Washington 58% 63% 69% 53% 29% 51% 76% West Virginia NA 44% 53% 73% 35% 35% 63% Wisconsin 56% 74% 85% 72% 58% 70% 83% Wyoming NA 55% 70% NA NA 72% 58% NOTES: NA= estimate does not meet minimum standard for statistical reliability. SOURCE: Kaiser Family Foundation analysis of March 2018 Current Population Survey. Understanding the Intersection of Medicaid and Work: What does the data say? 17 Endnotes 1 As of July, 2019, an appeal was underway in the DC Circuit after a federal trial court stopped implementation of Arkansas’s work and reporting requirements in March 2019 and prohibited Kentucky’s waiver from going into effect in April as planned. On July 29, 2019, the court set aside the Granite Advantage Health Care Program demonstration, approved by CMS on Nov. 30, 2018. Implementation of the work requirement and the elimination of retroactive eligibility is stopped unless and until HHS issues a new approval that passes legal muster or prevails on appeal. Previously, on July 8, 2019, NH enacted legislation that allowed for the suspension of the work requirement’s implementation up to but not after July 1, 2021, and suspended the work requirement through Sept. 30, 2019. 2 Harold F. O’Neil, Jr., ed. Work Readiness: Competencies and Assessment. (New York: Psychology Press), 2014. 3 Hope Clark, et al. Work Readiness Standards and Benchmarks: The Key to Differentiating America’s Workforce and Regaining Global Competitiveness. (Iowa City, IA: ACT), 2013; available at: http://www.act.org/content/dam/act/unsecured/documents/Work-Readiness-Standards-and-Benchmarks.pdf 4 Full-time workers include people working 35 hours or more, those who worked 1-34 hours for noneconomic reasons (e.g., illness) and usually work full-time, and people "with a job but not at work" who usually work full- time. People working full time may work at more than one job. 5 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 6 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 7 U.S. Department of Labor, Minimum Wage, https://www.dol.gov/general/topic/wages/minimumwage. 8 Tricia Brooks, Lauren Roygardner, and Samantha Artiga, “Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey,” (Washington, DC: Kaiser Family Foundation, March 2019), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies- as-of-january-2019-findings-from-a-50-state-survey/. 9 Rachel Garfield, Kendal Orgera, and Anthony Damico, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid,” (Washington, DC: Kaiser Family Foundation, March 2019), https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand- medicaid/. 10 Kaiser Family Foundation analysis of 2018 CPS ASEC. 11 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 12 Kaiser Family Foundation analysis of Outgoing Rotation Group data in 2018 Current Population Survey 13 Kaiser Family Foundation analysis of 2018 CPS ASEC. 14 Includes people who have at least two of the following chronic conditions: Hypertension, High Cholesterol, Coronary Heart Disease, Angina, Myocardial Infarction, Heart Condition, Stroke, Emphysema, COPD, Asthma, Cancer, Diabetes, Arthritis. 15 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 16 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 17 Based on respondents saying they feel depressed daily, weekly, or monthly. 18 Kaiser Family Foundation analysis of 2017 National Health Interview Survey (NHIS). 19 Question asks “How often do you use a computer?” and does not specify whether or not to include handheld devices such as smart phones. 20 Based on questions asking “Do you use the Internet” and “How often do you use the Internet”. Questions do not specify whether or not to include internet use on handheld devices such as smart phones. 21 Based on questions asking “Do you send or receive emails” and “How often do you check this account”. Questions do not specify whether or not to include email use on handheld devices such as smart phones. Understanding the Intersection of Medicaid and Work: What does the data say? 18 22 MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, “Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees,” (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of- enrollees/. 23 MaryBeth Musumeci, “Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018,” (Washington, DC: Kaiser Family Foundation, June 2019), https://www.kff.org/medicaid/issue-brief/disability-and-technical-issues-were-key-barriers-to-meeting-arkansas- medicaid-work-and-reporting-requirements-in-2018/. 24 MaryBeth Musumeci, “Medicaid Enrollees and Work Requirements: Lessons From the TANF Experience,” (Washington, DC: Kaiser Family Foundation, August 2017), https://www.kff.org/medicaid/issue-brief/medicaid- enrollees-and-work-requirements-lessons-from-the-tanf-experience/. 25 United States. “A Budget for a Better America, Fiscal Year 2020.” Budget of the U.S. Government. (Washington, DC: United States Government, March 2019), https://www.whitehouse.gov/wp-content/uploads/2019/03/budget- fy2020.pdf. 26 MaryBeth Musumeci, Robin Rudowitz, and Barbara Lyons, “Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees,” (Washington, DC: Kaiser Family Foundation, December 2018), https://www.kff.org/medicaid/issue-brief/medicaid-work-requirements-in-arkansas-experience-and-perspectives-of- enrollees/. 27 Benjamin D. Sommers, Anna L. Goldman, Robert J. Blendon, E. John Orav, and Arnold M. Epstein, “Medicaid Work Requirements – Results from the First Year in Arkansas,” (New England Journal of Medicine, June 19, 2019), doi: 10.1056/NEJMsr1901772, https://www.nejm.org/doi/full/10.1056/NEJMsr1901772. 28 Arizona Health Care Cost Containment System (AHCCCS), State Medicaid Advisory Committee (SMAC), Slide 15: “AHCCCS Works Geographic Phase-in Recommendation,” available at: https://www.azahcccs.gov/AHCCCS/Downloads/SMAC/agendas/SMACAgenda07112019.pdf#page=58. Understanding the Intersection of Medicaid and Work: What does the data say? 19