Iowa and Missouri do not plan to use Medicaid unemployment exemption — The Guardian
In the United States, Iowa and Missouri do not plan to use an exemption from the new Medicaid requirements for residents of counties with high unemployment, although both states have areas that may qualify for it. The Guardian reported this, citing a study by the nonprofit organization KFF.
New Medicaid requirements
The federal requirements, which are set to take effect on January 1, stipulate that adults enrolled in the Medicaid expansion program under the Affordable Care Act must work, study, volunteer, or engage in other permitted activities for at least 80 hours per month to retain their insurance coverage.
The law also provides exemptions for people who are hospitalized, need to travel to receive medical care, live in areas affected by natural disasters, or in counties with high unemployment. New York applied the high-unemployment exemption to the Bronx, where the new requirements would otherwise have affected about 200,000 residents.
Political and administrative factors
Jennifer Tolbert, deputy director of KFF's Program on Medicaid and the Uninsured, suggested that states' refusal may be related both to ideological support for work requirements and to additional administrative burdens. According to her, to apply the exemption, states must regularly submit data to the Centers for Medicare & Medicaid Services and adapt eligibility determination systems.
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Sarah Gordon, an associate professor at the Boston University School of Public Health, said that states not using this exemption are generally more politically conservative and support linking health insurance to employment or other socially beneficial activity.
Joel Ferber, director of advocacy at Legal Services of Eastern Missouri, called Missouri's position disappointing. According to him, state authorities explain their refusal by not wanting to create additional bureaucratic procedures for program participants.
Experts also recalled Arkansas' experience, where Medicaid work requirements were introduced in 2018. By the end of that year, more than 18,000 people had lost coverage, while researchers recorded no significant increase in employment. Jacob Wallace, an associate professor at the Yale School of Public Health, noted that such requirements historically do not encourage employment but create administrative and paperwork barriers that can cause people to drop out of the program.
