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Katie Martin, Vice President

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Women Just Can’t Win: Medicaid Work Requirements and Inadequate Workplace Policies

February 28, 2018 | Health Care

Here’s an idea for politicians who claim they want to help women and families become more financially secure: Don’t institute punishing work requirements in programs that are meant to help people achieve and maintain economic security. Instead, promote and protect access to affordable, quality health care and supportive workplace policies.

This appears to be a foreign concept for the Trump administration and congressional leadership. Last month, the Centers for Medicare & Medicaid Services (CMS) approved problematic work requirements in Kentucky and Indiana’s Medicaid programs. Trump followed suit with a 2019 budget that proposes work requirements for critical programs that lift women and families out of poverty and combat persistent inequality.

Medicaid work requirements are especially punitive for women, who must contend with workplaces that don’t reflect or support the complexity of their lives in order to meet stringent work requirements under Medicaid and maintain the health coverage they need.

Medicaid is a vital source of health coverage for millions of women: 17 percent of women in the United States are enrolled in Medicaid. Due to racism and other systemic barriers that have contributed to income inequality, women of color are disproportionately likely to be insured through Medicaid: 31 percent of Black women and 27 percent of Hispanic women aged 15–44 were enrolled in Medicaid in 2015, compared with 16 percent of white women. Medicaid pays for nearly half of all U.S. births and is the largest payer of publicly funded family planning services.

Most women who are enrolled in Medicaid (56 percent) already hold jobs. Many of those who do not are caring for family members, have a serious illness or disability or attend school. Still, nearly two-thirds of those at risk of losing Medicaid coverage because of work requirements are female.

It is already challenging for women with health conditions or who are caring for loved ones to work, and Medicaid work requirements will only make this harder. This is in part because far too few women have access to paid family and medical leave. In fact, fewer than 60 percent of workers have access to unpaid leave under the Family and Medical Leave Act (FMLA), leaving more than 40 percent without access to job protection when they need to take leave for medical reasons. This means, for example, that a woman not covered by the FMLA who is enrolled in Medicaid could lose her job if she takes time away from work to get cancer treatment, and then lose her health coverage due to Medicaid work requirements. Losing Medicaid could be a death sentence for this woman. At the very least, this would severely threaten her ability to get the care she needs and maintain her economic stability.

Medicaid work requirements could also block people with hourly and seasonal jobs from keeping their coverage. Women make up two-thirds of the nearly 23 million low-wage workers in the United States. Many low-wage workers have variable hours, and an inflexible Medicaid work requirement could cost them health coverage if their hours drop below a certain level.

Seven in 10 low-wage workers are unable to earn a single paid sick day. For these low-wage workers who are enrolled in Medicaid, a single sick day could mean losing their job and then their health care. Job loss due to lack of paid sick days is not uncommon. Overall, nearly one in four U.S. adults reports having lost a job or being told they would lose a job for taking time off due to illness or to care for a sick family member. In addition, women are more likely to be primary caregivers of children and older adults, making them particularly vulnerable if they need to take a sick day to care for a loved one.

Even if the United States adopted family friendly workplace policies, Medicaid work requirements would still be punitive, ineffective, administratively burdensome and entirely without justification. These requirements are about driving people off Medicaid, not empowering them or improving their lives. In fact, the states applying for waivers to implement work requirements even acknowledge estimated coverage losses in their applications.

Ultimately, states that choose to implement Medicaid work requirements will compound the harm women already experience from inadequate workplace policies, undermining women’s health, well-being and economic security. More states should instead expand Medicaid — without work requirements — and connect more women to the health care they need to get and stay healthy.


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