With approval from the Trump administration, the state of Arkansas rolled out work requirements for Medicaid recipients in June 2018. In the following months, 18,000 adults fell off the Medicaid rolls, though it was not clear exactly why. Did some number, spurred by the work requirements, find new jobs that provided health insurance, eliminating their need for Medicaid?

A new study published in The New England Journal of Medicine answers that question, finding that the people who lost their insurance did not find new jobs. Researchers found instead that the policy reduced the insured rate among the roughly 100,000 30-to-49 year-olds targeted by the work requirements.

“The idea of work requirements is to get people into new jobs and private insurance. But in our study that didn’t happen,” said lead author Benjamin Sommers of Harvard University’s School of Public Health. “We didn’t find any employment changes and instead we see Medicaid coverage rates dropping and more people without health insurance–usually because the process itself was confusing or beneficiaries didn’t even know about the new requirements.”

The findings prompted some critics to question the purpose of the work requirements, which are being rolled out in numerous states. “If Medicaid work requirements don't lead to more work, what should we conclude about whether they work?” asked Larry Levitt of the Kaiser Family Foundation. Answering his own provocative question, he wrote: “Maybe they're more about differentiating between the so-called deserving and undeserving poor.”