Medicaid: Work Requirements

The Issue:  Medicaid Work Requirements

Where We Stand:

NAMI opposes any effort to take Medicaid coverage away from people who don’t meet a work requirement. Work requirements compromise access to care for people with mental health conditions and hampers their ability to maintain or seek employment.

Why We Care:

Access to coverage and care is essential for people with mental illness to successfully manage their condition and get on a path of recovery. Medicaid is the lifeline for much of that care. It is the nation’s largest payer of mental health and addiction services and provides health coverage to 27 percent of adults with a serious mental illness.

In January 2018, the federal Centers for Medicare and Medicaid Services (CMS) reversed longstanding Medicaid policy and began allowing states to request Medicaid demonstration waivers that condition Medicaid eligibility on an individual’s work status. This policy change puts millions of people with mental health conditions at risk.

Medicaid work requirement policies:

  • Put people at risk of losing their mental health care;
  • Create barriers to maintaining health coverage;
  • Do not help people with mental health conditions get or keep a job; and
  • Are expensive for states to implement, diverting scarce resources from Medicaid’s goal of keeping America healthy.

How We Talk About It:

  • 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 and crisis and hospital care.
  • NAMI supports the 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 1 in 20 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 merely increase state administrative costs and complexity.
  • Rather than spending scarce public resources on imposing work requirements, NAMI urges states to invest in robust, evidence-based Supported Employment programs that many people with mental illness need to get and keep competitive employment.
  • 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; and
    • 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.

What We’ve Done:

  • NAMI News “Federal Judge Helps Protect People On Medicaid”
  • NAMI’s amicus brief in the lawsuit against work requirements in Kentucky
  • NAMI’s amicus brief in the lawsuit against work requirements in Arkansas
  • NAMI submits comments on individual state proposals to expand Medicaid. These comments are available by request