Medicaid Work Reporting Requirements

Where We Stand

NAMI believes that public policies and practices should promote access to care for people with mental health conditions. NAMI opposes efforts to take Medicaid coverage away from people who don’t meet a work reporting requirement.

Why We Care

Access to health insurance coverage is essential for people with mental illness to access mental health care and successfully manage their condition. Medicaid is a lifeline for tens of millions of Americans as the nation’s largest payer of mental health condition and substance use disorder (MH/SUD) services, and nearly 40% of nonelderly adults covered by Medicaid have a MH/SUD. Through Medicaid coverage, people with mental health conditions can access critical services like psychotherapy, inpatient treatment, prescription medications, and crisis care.

Currently, Medicaid eligibility is not tied to employment. However, proposals to add work reporting requirements continue to be circulated as a cost-saving measure in Medicaid. Work reporting requirements would require people to meet a certain number of hours working, or engaging in other qualifying activities, to keep their Medicaid coverage. If a work reporting requirement were implemented, someone who is unable to comply with the requirements can be cut off from essential health care coverage. These work reporting requirements create unnecessary and extensive administrative hurdles for working people and families that jeopardize access to needed mental health care.

NAMI supports the goal of helping people with mental illness gain meaningful employment, and most people on Medicaid who can work already do so. More than 90% of adults with Medicaid coverage are either already working, caregivers, students, or unable to work due to illness. Work reporting requirements in Medicaid don’t result in increased employment. Instead, they put people with mental health conditions at risk by creating barriers to maintaining health coverage or cutting them off entirely. When faced with a crisis, we want people to be able to get the health care they need, not focus on filling out paperwork.

While states may exempt some vulnerable people from work reporting requirements, most states do not have effective systems to successfully implement these exemptions. Additionally, some people, including people with mental illness, who are not able to navigate the complex paperwork and reporting requirements will inevitably fall through the cracks and lose their coverage. For example, in Arkansas in 2018, about 1 in 4 enrollees subject to the requirements — about 18,000 people — lost coverage in only seven months before a federal court halted the program. Many people who lost coverage were working, but could navigate reporting requirements. There are also some people with mental illness who have not yet been determined disabled, but who may not be able work immediately or navigate the exemption process, including young adults experiencing their first symptoms of serious mental illness, like early episodes of psychosis, or people who have been discharged from psychiatric hospitalization but need intensive outpatient treatment.

Work reporting requirements are also costly to implement. The work reporting requirements proposal in Michigan had estimated administrative costs between $17.5 million and $70 million. In Georgia, work requirements cost about $13,360 per enrollee, with only about one-third of the spending on health care and the rest on systems modifications to implement work reporting, additional staff, and other administrative expenses. Moreover, when people lose access to mental health services and supports, state costs may increase as people with mental illness are pushed into costly emergency rooms, hospitals, and jails.

Rather than spending scarce public resources on imposing work requirements, NAMI urges states to invest in robust, evidence-based supported employment programs which help people with mental illness get and keep competitive employment.

How We Talk About It

• About one in five people in the United States has a mental health condition, but only about half get needed treatment each year.
• Access to health care coverage and mental health care is essential for people with mental illness to successfully manage their condition.
• Medicaid is critical to helping people with mental health conditions, and roughly 40% of people on Medicaid have a mental health condition or substance use disorder.
• Medicaid pays for vital services that people with mental health conditions rely on, such as medications, psychotherapy, intensive and inpatient treatment, peer support, and crisis care.
• Work reporting requirements in Medicaid would require people to work a certain number of hours to keep their Medicaid coverage.
• NAMI supports the goal of helping people with mental illness gain meaningful employment, and most people on Medicaid who can work already do.
• However, there is no evidence that taking away people’s health insurance leads to or supports long-term, stable employment.
• Additionally, many people with mental illness may see their coverage at risk because they may not be able to meet the requirement or do not yet meet requirements for exemption.
• Most states do not have effective ways to exempt vulnerable people from work reporting requirements, so people with mental illness may fall through the cracks and lose their coverage.
• There are also people with mental illness who have not yet been determined disabled, but may not be ready to work, including young adults experiencing their first symptoms of mental illness or people experiencing severe symptoms that make navigating the disability system difficult.
• Work reporting requirements are also costly for states to implement.
• The only “work” that work reporting requirements would create is more paperwork.
• Work reporting requirements are simply another way to cut people off Medicaid. Cutting off Medicaid for people with mental illness won’t improve their mental health —or help them get or keep a job.
• NAMI urges policymakers to reject policies that take Medicaid away from people who don’t meet a work reporting requirement.

What We’ve Done

• NAMI-led coalition letter to Congress on protecting Medicaid for people with mental health conditions and substance use disorders
• NAMI coalition letter to Congress on protecting Medicaid for people with serious, acute, and chronic health conditions
• NAMI News “Federal Judge Helps Protect People On Medicaid”
• NAMI amicus brief in the lawsuit against work requirements in Kentucky
• NAMI amicus brief in the lawsuit against work requirements in Arkansas