Ku Leighton, Brantley Erin, Steinmetz Erika, Bruen Brian K, Drishti Pillai
Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, D.C.
Issue Brief (Commonw Fund). 2018 Nov 1;2018:1-12.
The Centers for Medicare and Medicaid Services approved Medicaid work requirement demonstration projects in four states, and other states also have applied. However, the future of these projects has been clouded by legal and policy challenges.
To assess whether state Medicaid work requirement projects are designed for success in promoting employment among unemployed Medicaid beneficiaries.
To examine the design of new work requirement projects, we reviewed the evidence, analyzed the overlap of Medicaid and Supplemental Nutrition Assistance Program (SNAP) work requirements, and convened a roundtable of seven experts who have research or implementation experience with work programs for Medicaid and public assistance recipients.
Mandatory work programs would be less effective and efficient than well-administered voluntary programs. Far more people will be subject to Medicaid work requirements than are currently subject to them in SNAP. This surge could overwhelm the limited resources of existing employment training and support programs. Medicaid demonstration projects contribute almost no additional funding to train the unemployed or provide necessary social supports. Medicaid work requirement programs are not well designed to help people get jobs or improve health and are more likely to lead to a loss of health insurance coverage.
医疗保险和医疗补助服务中心批准了四个州的医疗补助工作要求示范项目，其他州也已申请。然而，这些项目的未来因法律和政策挑战而蒙上阴影。
评估各州医疗补助工作要求项目在促进失业医疗补助受益人就业方面是否设计得当以取得成功。
为研究新工作要求项目的设计，我们审查了相关证据，分析了医疗补助与补充营养援助计划（SNAP）工作要求的重叠情况，并召集了一个由七名专家组成的圆桌会议，这些专家在医疗补助和公共援助受助人工作项目方面具有研究或实施经验。
强制性工作计划在效果和效率上不如管理良好的自愿性计划。将有更多人受到医疗补助工作要求的约束，比目前补充营养援助计划中的受约束人数要多得多。这种激增可能会使现有就业培训和支持项目的有限资源不堪重负。医疗补助示范项目几乎没有额外资金用于培训失业人员或提供必要的社会支持。医疗补助工作要求项目在帮助人们就业或改善健康方面设计不佳，更有可能导致医疗保险覆盖范围的丧失。
