For several years, Eric Wunderlin faced challenges in maintaining steady employment due to his health issues. Living with depression and diabetes, he worked part-time retail jobs in Dayton, Ohio, but earned so little that he often had to choose between paying rent and buying food.
In 2018, Medicaid, through the CareSource health plan, connected Wunderlin with a life coach who assisted him in finding a full-time job with health benefits. He now works for a nonprofit social service agency, which has provided him with financial stability to the extent that he plans to vacation in Europe next year. Wunderlin expressed feeling revitalized and more integrated into society.
Republicans in Congress and several states, including Ohio, Iowa, and Montana, are advocating for work requirements for non-disabled adults receiving Medicaid, asserting that such stipulations would encourage employment among recipients. Wunderlin’s story may be used to illustrate how government healthcare can facilitate employment opportunities, potentially decreasing the need for public assistance.
However, Wunderlin’s situation is considered atypical as Medicaid generally does not offer direct employment support. Critics of the mandate highlight that most Medicaid recipients are already employed. According to data from KFF, two-thirds of Medicaid beneficiaries work, while others are caregivers, students, or unable to work due to disability or illness. Observations from existing programs suggest limited success in boosting employment rates among recipients, as noted by Ben Sommers, a professor of healthcare economics.
Policy discussions continue regarding the potential implementation of work requirements as a means to reform Medicaid. While the Trump administration supported these mandates, many were invalidated by federal judges. Experts argue that more focus should be placed on initiatives that can genuinely aid in economic mobility, such as personalized coaching and job training programs.
Only Georgia and Arkansas have implemented work-related mandates for Medicaid enrollees, but studies indicate these do not significantly increase job activity since most who can work are already employed. In Arkansas, many individuals lost their Medicaid coverage due to difficulties in meeting reporting requirements. Since then, the state has incentivized health plans to provide job training, although uptake has been limited.
States like California and Ohio are requiring Medicaid-managed insurance companies to assist enrollees in seeking employment. Meanwhile, Montana’s initiative to integrate job training with Medicaid faced setbacks when its administration was outsourced, resulting in a sharp decline in participation.
Efforts to track the impact of these job programs are inconsistent, and there’s a call for improved data to evaluate their effectiveness. For example, the JobConnect program by CareSource supports enrollees in life and job skills development, and many have found employment as a result. Nonetheless, state officials, such as those in Ohio, note that Medicaid plans are not job agencies, complicating the assessment of their success in this area.
Across the nation, states continue to explore innovative Medicaid benefits to support employment among enrollees, with varying degrees of scale and success. However, there is still debate about the balance between incentivizing work and ensuring comprehensive healthcare access for low-income individuals.
