Medicaid Work Requirements Will Have Negative Impact on Children's Health, Report Says

Medicaid work requirements will ultimately harm children’s health if their parents lose health benefits, a new policy report says.

The report from the Center on Budget and Policy Priorities (CBPP) says that when parents have health insurance, children are more likely to be insured as well. After the Affordable Care Act (ACA) allowed for the expansion of Medicaid, the uninsured rate for children dropped to 4.5% by 2016.

In states that expanded Medicaid under the ACA, both parents and adults without children with incomes up to 138% of the federal poverty line are eligible for Medicaid.

While children in low-income families were already eligible before the ACA and Medicaid expansion, the report highlights evidence linking gains in coverage for parents into gains in coverage for children, meaning these vulnerable populations were more likely to get the care they needed.

In states that haven’t expanded Medicaid, low-income parents are the primary aim of work requirements, because adults without children are generally ineligible for Medicaid. Many of these states’ proposals will put parents in nonexpansion states in a no-win situation:

• They’ll lose coverage if they don’t comply with the work requirements
• They’re still likely to lose coverage if they do comply, because their income would likely exceed their states’ very low Medicaid eligibility thresholds
• They won’t have an opportunity to get other health insurance through the low-wage jobs they may obtain or be able to afford otherwise

Expansion states with approved work requirement policies, or considering them, have different policies regarding the ages at which they exempt parents of minor children.

• Indiana exempts only parents of children age 6 and under
• Kentucky and Arkansas generally exempt parents of minor children
• New Hampshire’s work requirement proposal under review by CMS would also only exempt parents of children age 6 and under
• Michigan’s legislature is considering a work requirement that would only exempt parents of infants under 3 months

The CBPP said Medicaid enrollment increased disproportionately for children whose parents became newly eligible, citing a study from last year showing that more than 700,000 children in Medicaid expansion states gained coverage from 2013 to 2015—more than double the number of children in nonexpansion states who gained coverage.

In addition, when their parents have coverage, children have improved access to care, wrote the CBPP, citing another study that said children are 29 percentage points more likely to have an annual well-child visit if their parents are enrolled in Medicaid

Children’s health and development are at risk when parents do not have access to care and suffer from poor mental health, the report added. In addition, the financial insecurity caused by losing health coverage would add another layer of stress in the household.

Without Medicaid, children would lose access to health services under the Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This benefit guarantees that children and adolescents under the age of 21 have access to a set of comprehensive and preventive health services, including regular well-child exams; hearing, vision, and dental screenings; and other services to treat physical, mental, and developmental illnesses and disabilities. The loss of EPSDT would be particularly harmful to children with special healthcare needs, as Medicaid is the only source of coverage for over one-third of these children, the CBPP said.