Starting next year, many adults who receive benefits from Medicaid, the government-sponsored health coverage program for low-income and disabled people, will need to prove they're working, volunteering or searching for a job.
The federal directive was included in last year's massive spending bill and is designed to foster "agency" and "community engagement" among recipients.
But an analysis of Missouri census data shows that two-thirds of the state's adult Medicaid recipients are already working.
Researchers at the Washington University Center for Advancing Health Services, Policy and Economics Research found Missourians ages 19 to 64 who would be held to the work requirement held full-time (38%) or part-time (29%) jobs. Others who didn't work cited disability, illness, caregiving or retirement as reasons they didn't work.
About 12% of those ages 19 to 64 on Medicaid said they were not working "due to other reasons."
Tim McBride, a professor at the WashU School of Public Health and one of the policy brief's authors, said the requirements will require significant money and manpower to reach a relatively small share of Medicaid recipients who are not working.
"It seems like a lot of staffing and a lot of dollars to be spent on [around] 40,000 people, in my opinion," he said, adding, "I think it comes from a misperception of Medicaid recipients."
Congress last year, as a part of the One Big Beautiful Bill Act, passed work requirements for people within the Affordable Care Act's Medicaid expansion population. To receive federal Medicaid funding, states will need to put a reporting system in place. Medicaid enrollees must work, perform community service or go to school for at least 80 hours a month.
Critics have said the bureaucratic hurdles for reporting could mean otherwise eligible people lose coverage.
State officials have said they're focused on making complying with the reporting requirements as seamless as possible, using user-friendly online portals or existing state documents, such as income data, to verify eligibility without requiring direct contact with recipients.
The proportion of employed Medicaid recipients in MIssouri is roughly similar to that of the nation as a whole. However, 30% of recipients in Missouri live in rural areas, about twice the national rate.
Most recipients have completed high school but not college, or don't have a high school diploma.
The mix of lower educational attainment and rural residency likely makes it more difficult for Medicaid patients to find a job with health coverage, the authors wrote.
"If you're going to say there's a work requirement, then there has to be jobs available, or community engagement volunteer activities," McBride said. "And what we worry about is that they may not be available as readily."
Missouri will likely unveil how the reporting program will work later this year. Federal officials are expected to release more guidelines in the coming months about what they require of states' eligibility reporting programs.
Missouri's legislature is still finalizing its budget, which will clarify how much money the state could ultimately spend to implement the new work requirement.
This session, Missouri lawmakers are considering a bill from Rep. Darin Chappell, R-Rogersville, that would place work requirements for Medicaid in the state's constitution.
Chappell said the initiative would ensure "that we have the wherewithal and the budgetary flexibility to make sure that those dollars go to those individuals who are the most vulnerable among us."
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