The impact of Medicaid work requirements on access to substance use disorder treatment

Congress is currently considering introducing work requirements for Medicaid beneficiaries to keep their health care coverage or risk facing disenrollment. In a new paper published by Health Affairs Forefront by Dominic Hodgkin, Maureen Stewart, Shay M. Daily, Haiden A. Huskamp, and Richard G. Frank, the authors explore the sizeable impact of a Medicaid work requirement mandate on the population of Medicaid enrollees with substance use disorders (SUDs) at risk of losing health care coverage as a result of the proposed policy.

Using the 2023 National Survey on Drug Use and Health (NSDUH), the authors estimate that about 9 million individuals would likely have to abide by the work requirement to avoid losing their Medicaid coverage. Furthermore, the authors’ estimates show that 4.56 million people living with a SUD who are currently not meeting the strictest iteration of a work requirement are most at risk of losing their Medicaid from a work requirement policy and face additional challenges (such as drug tests, potential criminal records, mobility restrictions) to finding or retaining part-time or full-time employment.

With their new research, the authors suggest two potential policy considerations to mitigate the negative impact of the proposed federal policy:

• Some past State Medicaid policies allowed enrollees who identified as disabled, looking for work, or in school or training to stay enrolled within a looser work requirement. Given the data in 2023, the authors argue that this criterion would have applied to 2.29 million of the 4.56 million people with SUDs at risk of losing coverage, lowering the number of individuals at risk to 2.26 million.

• Other State Medicaid proposals have exempted enrollees currently receiving SUD treatment from the Medicaid work requirements. Without this exemption in the federal policy, the authors claim that 0.54 million people would lose their Medicaid eligibility and life-saving SUD treatment, and even then, 1.72 million people without current treatment will no longer be eligible for future Medicaid-covered SUD treatment. However, this does not address severe provider shortages for SUD treatment.

Given the authors’ findings and previous research on Medicaid work requirement implementation at the state level, they conclude that there is a substantial risk that a federal Medicaid work requirement policy would drive many enrollees, especially individuals with SUDs, to lose their health insurance coverage and access to current or future SUD treatment. The loss of treatment for people with SUDs not only can be associated with higher risks of drug overdose and emergency inpatient visits but also doesn’t improve their ability to find or retain a job in the future. The authors finally conclude that exemptions can be helpful for certain subgroups, as mentioned above, but they do not protect all individuals with SUDs from the negative impacts of a work requirement policy within Medicaid. Finally, consultations with SUD treatment providers and other experts are important for continuing to address the U.S. opioid epidemic.

Read the full article here