Medicaid Work 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 requirement.

Why We Care

Access to coverage and care is essential for people to successfully manage their mental health condition and get on a path of recovery. Medicaid is the lifeline for much of that care, paying for services that people need, such as medications, case management, therapy, peer supports and crisis and hospital care. Medicaid is the nation’s largest payer of mental health and addiction services and provides health coverage to 27% 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 means that if someone is unable to comply with work requirements, they can be cut off from essential health care coverage. NAMI supports the goal of employment and recognizes that people with mental illness are disproportionately unemployed. However, work requirements in Medicaid don’t advance the goal of employment for many people with mental illness. Instead, work requirements put people with mental health conditions at risk by creating barriers to maintaining health coverage.

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

• Across the country, millions of 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 one in five adults with mental health conditions who receive community mental health services are competitively employed — and the numbers drop to only one in ten for people with 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.
• Additionally, there are people with mental illness who have not been determined disabled, but may not be ready to work, including:
  • Young adults experiencing their first symptoms of 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.

What We’ve Done

• NAMI News “NAMI Applauds President Biden’s Efforts to Strengthen Access to Quality, Affordable Health Care”
• 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
• NAMI submits comments on individual state proposals related to work requirements. These comments are available by request.