Natasha Thomas, Policy Intern
In response to the federal Centers for Medicare & Medicaid Services announcement that states may proceed with adding work requirements to their Medicaid programs, we took a look at what research says about the effectiveness of work requirements in other federal public assistance programs: the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and federal housing assistance.
The Urban Institute released a research report last month on work requirements in public assistance programs. For the SNAP program, the report found that although incomes rise under work requirements, they are not enough to get recipients above the federal poverty line. It can be hard for SNAP recipients to find work if they have low education levels, criminal records, or are of racial and ethnic minorities, and individuals who fail to meet the work requirement are disqualified from assistance. According to research, about 68% of SNAP beneficiaries are exempt from work requirements, and 13% are already working. Therefore millions of taxpayer dollars are being used to enforce work requirements on the thin slice of the population that aren’t working, many of whom are either facing medical barriers to employment, taking care of people with critical health problems, retired, in school, or are stay-at-home parents.
The report also noted that there isn’t much information on the effectiveness of work requirements for people utilizing federal housing, however research does show that many residents, like those receiving SNAP, are either exempt from the work requirement or are already working. As for TANF, the report discusses the racial disparities found within state TANF policies. For instance, in states with a larger general population of African Americans, there tends to be more “severe sanctions for an initial incident of noncompliance with the work requirement” and less generous benefits. TANF recipients who are African American tend to be hired less often, have less stable employment, and cycle back to TANF. In addition, the report highlights that TANF rules lead caseworkers to spend more time tracking and verifying the work activities and hours of recipients, which limits the amount of time caseworkers can use to connect families to employment and other support services.
A recent research study on the effectiveness of various work programs utilized by TANF recipients subjected to work requirements found the following:
Employment rates increased modestly in the first two years for recipients subject to work requirements, but after five years employment was the same or lower than employment rates among recipients who were not subject to work requirements.
Any increases in stable employment among recipients subject to work requirements were very small, and such increases were the exception, not the norm.
Physical and mental health conditions that cause significant barriers to employment are more common among recipients of public assistance than among the general population, causing many recipients to not find employment even after participating in work programs deemed successful.
The most successful programs focused on furthering education and skills training in addition to helping recipients find a job, rather than only assisting with the job search. Recipients in human capital development programs were more likely to get employed, stay employed, receive higher wages, and be offered benefits.
Most recipients subject to work requirements either remained poor or became poorer. If they became employed, the increased earnings were not enough to raise them above the poverty line, and if they failed to find employment, the little assistance they received would be taken away.
Nationwide, about 35% of Medicaid enrollees who are not working are unable to work because of disability or illness. A 2015 National Health Interview Survey found that half of those with health care coverage under Medicaid expansion are in fair or poor health, have serious physical or mental limitations, or are permanently disabled. These medical conditions present barriers that make it difficult for people to find work or stay employed. Limiting or completely withdrawing people’s Medicaid coverage will not increase their chances of finding employment, in fact the opposite is true. Research shows that increasing health care coverage under Medicaid improves health, which leads to more success in job seeking, becoming employed, and staying employed.
An Ohio study on the impact of Medicaid expansion found that 27% of post-expansion enrollees were diagnosed with at least one chronic health condition, and 31.9% screened positive for depression or anxiety disorders, which limited routine activities such as employment. Almost half (47.7%) of the participants reported improvement in their overall health. Additionally, most reported that being enrolled in Medicaid made it easier to work, with 74.8% of those who were unemployed stating that enrollment made it easier to seek employment and 52.1% of those already employed reporting Medicaid coverage made it easier to continue working.
Another study by the University of Michigan showed that 55% of those covered under Medicaid expansion who were out of work said job seeking improved after coverage, and 69% of those already working reported doing better at work after gaining health insurance. For the nearly half of enrollees who reported improvement in their physical and mental health in the first year of coverage, they were four times more likely to also say that Medicaid coverage helped them do a better job at work.
According to the Colorado Health Institute, it is unlikely that under Gov. Hickenlooper Colorado will implement work requirements for recipients of Health First Colorado, the state’s Medicaid program. However, as this is an election year, the institute took a look at how such a provision would affect Coloradans if a future governor decided to do so. CHI estimates that about 75% of Medicaid recipients are already working, and the remaining 25% are either looking for work or meet the criteria for exemption. If Colorado were to hop on the Medicaid work requirements bandwagon, new barriers to health care would be created and money would be spent on administering work requirements with virtually no outcomes to show for it. Work requirements don’t help people get back to work, providing them health care first does.