Advancing health equity for older Americans receiving Medicaid
Requiring older Americans to work as a condition of receiving Medicaid could negatively and disproportionately affect many, Rodlescia Sneed suspects.
That’s why Sneed, Ph.D., MPH, an assistant professor in the College of Human Medicine’s Division of Public Health, is undertaking a two-year study to evaluate the potential impact of Medicaid work requirement on older recipients.
“I do think that certain groups may be impacted more than others,” said Sneed, noting in particular rural residents, non-English speakers, those lacking reliable transportation, populations of color and the medically vulnerable. “These are the people who really need Medicaid,” she said.
Sneed is among five researchers funded through Policies for Action’s, or P4A, special call for proposals issued last year to advance health equity by actively seeking new and diverse perspectives from the policy research field. Her study will receive $250,000 of funding through the P4A program.
P4A is a signature research program of the Robert Wood Johnson Foundation administered by the national coordinating center at the Urban Institute. The program explores how policies, laws and other system and community levers in the public and private sectors can support the foundation’s vision to build a Culture of Health.
In January 2018, the U.S. Centers for Medicare and Medicaid Services issued a policy allowing states to require workforce participation or other community engagement for working-aged recipients. Like other states, Michigan enacted a rule requiring an average of 20 hours of work, job training or volunteering, but a federal judge temporarily blocked its implementation.
Sneed plans to gather data from the University of Michigan’s Health and Retirement Study to evaluate the potential impact of the work requirement on low-income Americans between the ages of 51 and 64. Many likely have significant chronic diseases that make it difficult to find and maintain jobs, Sneed said, adding that many may lack computers or internet access to meet the reporting requirement.
With millions of workers unemployed due to the coronavirus pandemic, finding a job is even more difficult and many more likely have lost insurance and will need to apply for Medicaid, she said. In a post-pandemic era, however, states may have even greater interest in work requirement policies, as they face large revenue losses and budget-crippling Medicaid enrollment due to coronavirus-related Medicaid expansion.
Sneed noted that a disproportionate number of those dying from the coronavirus are low-income minorities.
“Those of us who do this work have always known there are disparities in healthcare,” she said. “I think all of that is really being played out now with COVID-19.”