Chronic Disease Burden Among Medicaid Beneficiaries over 50: The Potential Impact of Medicaid Work Requirements

Research Objective Since 2018, several states have proposed modifications to their Medicaid programs that require participation in employment or other community engagement activities as a condition of receiving Medicaid benefits. Proponents say that these requirements promote financial independence for families and individuals, while opponents argue that these requirements would disenfranchise the nation's most medically vulnerable citizens. While some studies have evaluated the impact of impact of work requirements on the general Medicaid population, there has been little inquiry into the impact of such policies on Medicaid recipients over 50, who likely have high chronic disease burden and who may face difficulties in maintaining employment. The purpose of our study was to describe the prevalence and burden of chronic disease among Medicaid beneficiaries over 50 who might lose Medicaid benefits based on these new requirements. Study Design To address our research question, we conducted cross‐sectional secondary analyses of data from the 2016 wave of the Health and Retirement Study, a large‐scale, nationally representative, population‐based study of community‐dwelling adults aged >50. We used logistic regression models to examine the association between several chronic health conditions and reduced workforce participation (e.g. working <20 hours per week). All analyses adjust for age, race/ethnicity, sex, education level, and marital status. Population Studied Our population of interest included individuals over 50 who were not Medicare‐eligible and not receiving Social Security Income. We compared those working >20 hours per week to those working <20 hours per week. We chose <20 hours per week as our employment cutoff, as most states have used this cutoff as the threshold for determining continued Medicaid eligibility. Our sample included 1028 participants who were 47.69% Non‐Hispanic White, 23.29% Hispanic, 18.87% Non‐Hispanic Black, and 10.14% other racial/ethnic backgrounds. Participants were ages 51–64 (mean age 57.18; SD 0.212) and 55.47% female. Principal Findings Individuals with reduced workforce participation had greater prevalence of several chronic health conditions, including higher rates of diabetes, hypertension, arthritis, and lung disease. Further, among those with chronic health conditions, those working <20 hours per week reported more worsening of their chronic conditions in the past 2 years, greater use of disease‐related medications, more hospital and emergency department visits, and more functional limitations than their counterparts working at least 20 hours per week. Conclusions Taken together, these findings suggest that Medicaid work requirements in this population would have great impact on the most medically vulnerable individuals in this age group. Further, they suggest that reduced workforce participation may be a proxy for poor health. Implications for Policy or Practice Policymakers should consider these findings as they enact policies impacting Medicaid eligibility in this population. Enacting work requirements as a condition of Medicaid eligibility among individuals in this age group may have negative impact on chronic disease management. Primary Funding Source The Robert Wood Johnson Foundation.