Study Finds Work Requirements, HSA’S May Limit Coverage, Access

June 21, 2018

A study released on June 20, 2018, by the Harvard T.H. Chan School of Public Health finds that states’ current experimental approaches to Medicaid eligibility—including requirements to pay premiums, contribute to health savings accounts, or to work—may lead to unintended consequences for patient coverage and access, such as confusing beneficiaries or dissuading some people from enrolling. Produced by lead author Benjamin Sommers, associate professor of health policy and economics at the Harvard Chan School, results of the study suggest some of the benefits of expanding Medicaid may be partially compromised by some of the Medicaid program innovations that are in use, such as Indiana’s program.

Sommers and colleagues drew from a survey of low-income adults in three states with different Medicaid policies: Indiana, which expanded Medicaid using POWER health savings accounts via a Section 1115 waiver; Ohio, which expanded eligibility for traditional Medicaid; and Kansas, which has not expanded Medicaid. The study was supported by the Commonwealth Fund and the REACH Healthcare Foundation, and published in Health Affairs.

More than 2,700 non-elderly adults with family incomes at or below 138 percent of the federal poverty level were surveyed in Indiana, Kansas and Ohio. The survey was fielded between November 9, 2017, and January 2, 2018.

Key Findings

  • Ohio had significantly higher rates of Medicaid coverage compared to Kansas (53% vs. 36%) as well as lower uninsured rates (15% vs 20%). But there was no significant difference between Ohio and Indiana, the two expansion states.
  • The rate of delayed care due to costs were higher in Kansas and Indiana than in Ohio.
  • Among enrollees in Indiana, 39 percent said they had not heard of the state’s POWER health savings accounts, 26 percent had heard of them but were not consistently making required payments, and 36 percent were making regular payments. The most common reason for nonpayment into the POWER accounts was affordability (31%).
  • Among those familiar with POWER accounts, 57 percent agreed or strongly agreed that their account “helps me think about the health services I really need.” Meanwhile, 40 percent agreed or strongly agreed that the accounts were hard to understand or made it difficult to obtain necessary care.
  • In Kansas, work requirements would affect only a small share of the potential population. Of those with Medicaid or without coverage (and presumably eligible under expansion), 49 percent were working and 34 percent had a disability that kept them from working. Eleven percent were not working and said they would be more likely to look for a job if it were required for receiving Medicaid.

Read the Press Release

Read the Commonwealth Fund article

Read the Abstract

Study Contact: Benjamin D. Sommers, Associate Professor of Health Policy and Economics, Harvard T.H. Chan School of Public Health




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