Medicaid Work Requirement Programs Likely to Have a Significant Spillover Effect on Community Health Center Capacity, Staffing and Services

WASHINGTON, DC and NEW YORK, NY (June 26, 2019) – More than 100,000 people could lose access to comprehensive primary and preventive care at community health centers as a result of approved Medicaid work requirement programs, according to an analysis released today by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH). 

Previously, the Collaborative estimated reductions to Medicaid coverage in three states with approved Medicaid work experiment programs – Arkansas, Kentucky and New Hampshire. Building on estimates of coverage losses among Medicaid beneficiaries subject to work experiments prepared for the Commonwealth Fund by Milken Institute SPH researchers Leighton Ku, PhD, MPH, and Erin Brantley, MPH, the new analysis presents estimates of the impact of Medicaid work experiments on beneficiaries who are patients of health centers, and ultimately, the spillover consequences for health centers and the wider communities they serve.

The health center estimates focus on seven states and use government data from 2017 to gauge the effects of work experiments on patients, health center revenue, and health center staffing. This analysis presents first-time estimates for Arizona, Indiana, Ohio and Michigan, as well as updated estimates for Arkansas. It also includes estimates reported earlier for Kentucky and New Hampshire.

Across these seven states, the analysis shows that between 120,000 to 169,000 adult health center patients insured through Medicaid could be expected to lose their coverage during the initial experiment year. As a result of declining Medicaid coverage, health centers in these states would experience aggregate revenue losses ranging from $89 million to $125 million. Revenue losses of this magnitude would be expected to reduce patient care capacity in health centers in these states by 104,000 to 147,000 patients and staffing by between 815 and 1,145 full-time equivalent staff.

“This study shows how allowing states to build poorly designed and needless barriers to Medicaid coverage can hurt not only individuals but entire community health systems,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH and one of the authors of the report.

While all community health centers in the seven states would be affected, those in Kentucky and Michigan would be hardest hit. Health centers in those two states would be expected to lose up to $75 million in Medicaid revenue, and 664 full time jobs, with 88,000 people losing access to health care as a result, according to the analysis.

“The widespread adoption of Medicaid work requirements will have substantial and long-term spillover effects, dramatically increasing the number of people who are uninsured and, as a result, substantially reducing health center revenue and threatening access to care,” said Feygele Jacobs, DrPH, president and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program.

The analysis, “How Would Medicaid Losses in Approved Section 1115 Medicaid Work Experiment States Affect Community Health Centers?” can be accessed here.

A related blog by Ku and Brantley was published by the Commonwealth Fund and can be accessed here.

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The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.