About 48,000 Kentuckians wouldn’t have met the community engagement requirements — otherwise known as work requirements — if Gov. Matt Bevin’s changes to Medicaid had gone into effect as planned last year. That’s a smaller number than the 95,000 people over five years that were originally estimated by the state to be at risk of losing coverage.

The new estimate comes from a study from the University of Pennsylvania released last month. Those proposed community engagement requirements include making some enrollees work, volunteer, take GED courses or other activities for 80 hours a month to keep Medicaid insurance.

Bevin’s proposed changes to the program would affect Medicaid enrollees who gained coverage during the program’s expansion under the Affordable Care Act. The community engagement requirement hasn’t gone into effect; it’s being challenged by advocacy groups and has been tied up in court since last year.

Still, Cabinet for Health and Family Services Secretary Adam Meier said the analysis gives his team a good idea of what to expect if a judge eventually rules the Medicaid changes are legal. He cautioned, however, that the analysis should be taken with a grain of salt.

“It comes with the caveat that its self-reported data – it’s not objective, quantitative data,” Meier said. “All that said, it’s certainly going to give us a good idea of what to expect and it’ll be good for planning purposes.”

The state has touted career centers that have been set up or expanded to help Medicaid enrollees find work or receive education to meet the requirements. Meier said that despite the lower than expected estimate of people who aren’t working at all, there’s still a role for these career centers, even for people that are working 20 hours a week.

“We want them to meet with a career center specialist, we want them to get résumé support, whatever that pathway that’s appropriate for them,” Meier said. “We have a number of people that are out there that are working in a field that doesn’t have the upward mobility that allows them to be fully self-sustaining.”

The Study

The study was conducted in part by Atheendar Venkataramani, who’s on the team from the University of Pennsylvania that will analyze real-time data if the Medicaid changes take effect. He said there’s mixed research on whether work requirements in other welfare programs reduce poverty rates and get people into better-paying jobs. But there’s a lot of interest in how Kentucky’s program will impact enrollees.

“It’s an open question in the Medicaid program as to whether it’ll achieve this specific objective or not,” Venkatarmani said.

Venkatarmani and the other study authors analyzed actual data from the Kentucky Medicaid system in February 2018. Then, 9,000 Medicaid enrollees were surveyed between May and September 2018 and asked about their work, volunteer and other activities. Researchers extrapolated those findings to the 330,075 Medicaid enrollees that were in the program in February.

They found a large portion would have been exempt because they were already working, were in school or were primary caregivers. About a third of the people had SNAP, otherwise known as food stamps, or cash assistance program TANF, and would be excluded. That’s because both programs already have a similar work requirement program.

That left the 48,427 people who weren’t working or volunteering and didn’t qualify for any other kind of exemption. These people would have been at risk of losing coverage if the community engagement requirement had gone into effect.

Dustin Pugel, a health policy analyst at the Kentucky Center for Economic Policy, said this figure doesn’t include other people who could lose coverage, like those who will have to prove they’re medically frail or those who will have to make co-pays to stay in the program.

“The bottom line is that 132,000 people would have been at risk of losing their coverage due to this requirement,” Pugel said.

Pugel noted another analysis from The George Washington University estimated 86,000 and 136,000 Kentuckians could lose Medicaid coverage because of both the community engagement requirement, premiums and other payments people would have to make to keep coverage.