Work Requirements For Medicaid Hurt, Not Help

Jan 19, 2018

Across the country, more than 10 million people with mental illness rely on Medicaid, including many who live with severe conditions. Medicaid helps address the nation’s mental health care crisis by paying for services that people need, such as medications, case management, therapy, peer supports, crises and hospital care.

Recently, the Centers for Medicare & Medicaid Services (CMS) emphasized the goal of self-sufficiency through employment. On Jan. 11, CMS issued a State Medicaid Director letter supporting state Medicaid waivers that include work requirements for non-disabled Medicaid enrollees. On Jan. 12, CMS approved Kentucky’s Medicaid 1115 waiver, which included new work requirements.

NAMI supports the recovery goal of employment and recognizes that people with mental illness are disproportionately unemployed. Only 1 in 5 adults with mental health conditions who receive community mental health services are competitively employed—and the numbers drop to only 6.7% for adults with a diagnosis of schizophrenia.

Unfortunately, work requirements in Medicaid don’t advance the goal of employment for many people with mental illness. Studies of work requirements have shown they do not lead to long-term, stable employment. Instead, work requirements increase state administrative costs and complexity.

Rather than spending limited public resources on enforcing mandatory work requirements, NAMI urges states to invest in robust, evidence-based supported mployment programs that many people with mental illness need to get and keep competitive employment. Medicaid buy-in programs also help by letting employed people with disabilities keep their Medicaid coverage as their incomes rise.

Additionally, there are people with mental illness who have not been determined disabled, but may not be ready to work, including:

• Young adults with first symptoms of a serious mental illness.
• People whose mental health symptoms are so severe they cannot navigate the disability system.
• People who have discharged from psychiatric hospitalization but need ongoing treatment.

While states may exempt some vulnerable people from work requirements, most states do not have effective systems to do so. As a result, people with mental illness may fall through the cracks and lose their coverage.

Cutting off Medicaid for people with mental illness won’t improve their mental health—or help them get or keep a job.