In a new paper in JAMA Network Open, a team from the Leonard Davis Institute looked at the potential effects of Medicaid work requirements on Medicaid participation among those not actually subject to these requirements. They estimated that these “spillover effects”—which thus far have not been part of the conversation on work requirements—could be quite large. 

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Three years earlier, the team was hired to independently evaluate Kentucky’s proposed Section 1115 Medicaid waiver, which included work requirements. While creating its study design, it thought about the total effects of work requirements on Medicaid participation, and considered whether imposing work requirements—which focused specifically on those considered “able-bodied”—might have spillover effects on Medicaid participation among people who wouldn’t be subject to them.

Why might this happen? Complex changes to benefit programs may create confusion among would-be participants and the staff helping administer those benefits. Work requirements may also stigmatize participation or make benefits seem more out of reach. There is a pretty large literature suggesting that these spillover effects are meaningful and important to capture. A lot of this evidence comes from the welfare reform era. For example, the transition from the Aid to Families with Dependent Children (AFDC) program to the Temporary Assistance for Needy Families (TANF) program—which included imposition of work requirements—was associated with meaningful reductions in participation in programs like Medicaid. The team wanted to study whether this spillover phenomenon applied to Medicaid work requirements. Namely, could implementing a work requirement among one group of Medicaid beneficiaries impact participation among another unaffected group of beneficiaries?

Work requirements were still very new when they were designing the study, so they turned to history.

This article is by Atheendar Venkataramani. Read more at Penn LDI.

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