May 26, 2023

It sure sounds good when folks say, well, if you’re getting health care from Medicaid or help feeding your family, or any other help with essential needs, then you must meet work reporting requirements month after month to prove you are a “good” person.

It seems like, every so many years, some politician comes up with a fatuous old idea — one with a track record of failure — and touts it as a great new idea.

In Congress, we see yet another round of work reporting bureaucratic red tape being rolled out. But what does this look like under the hood? The Kaiser Family Foundation found an engine that sputters and stalls out.

A Kaiser foundation 2021 study provides a Medicaid owner’s manual with important facts about the program. Looking at people on Medicaid, 43% worked full-time and another 18% did part-time work. OK, so 6 of 10 people on Medicaid already work.

On top of that 61% of Medicaid enrollees who work, another 11% have a physical or mental disability, and another 13% stay home to care for a family member with a disability. So, adding disability or caring for a person who has a disability sums up to another 23%. (And remember that even if these folks don’t have to report work, they still must meet reporting requirements to show they are exempt from work. Red tape requirements can stop them from getting the health care they need.)

Summing up then, 84% of people on Medicaid either do work, are not able to work due to disability, or care for someone with a disability. Add to that another 6% of people on Medicaid who are enrolled in school. And another 9% who are currently looking for work or have not found a job.

This inspection shows that Medicaid provides necessary health care for folks who already work or have a good reason to be out of the workforce. Work reporting red tape requirements would be an expensive exercise to hunt for that last sliver of less than nine of every 100 people. It is like demolishing the car because you need a new windshield wiper.

In fact, red tape requirements are estimated to put 220,000 West Virginians at real risk of driving off a cliff with no way to see a doctor and stay healthy and productive.

Do you know anyone in your community who has someone in the family injured at work? Or a mine worker who can no longer work? Or a mother who stays home with a disabled child? I would be surprised if you did not, since West Virginia has one of the nation’s highest disability rates. West Virginians would be especially hard hit, if Congress moves forward with work reporting red tape in Medicaid.

A similar inspection of food stamps and other programs would show the same kind of crash: Low-income families would experience a negative health effect.

“Well, we can make exceptions,” say some politicians. But a test drive of work reporting requirements in Arkansas in 2018 failed to cross the finish line. In just a few months, over 40% of low-income adults lost their Medicaid and health care, and it was primarily due to procedural reasons (that is, folks didn’t have correct pay stubs or other documents, didn’t reapply on time, etc.) Data showed most folks who lost Medicaid were, in fact, qualified for Medicaid.

What we did learn from this test drive of work reporting requirements: It keeps state workers busy, is extremely costly for a state to administer, and doesn’t help anyone work.

The mechanics of policy need to remember:

  1. Healthier people equal more people working.
  2. Taking away Medicaid means more uninsured West Virginians who must seek crisis care in hospital emergency rooms. In turn, rural hospitals struggle to keep their doors open as uncompensated care grows.

In the end, work reporting requirements drive major cuts to the state health care infrastructure that hurt all of us. And that makes West Virginia a harder sell to potential newcomers. Work reporting requirements lead down a dead-end road for our economy.

Sharon Carte is board president of West Virginians for Affordable Health Care.

Cindy Harless


West Virginians for Affordable Health Care is a non-profit advocacy organization bringing a consumer voice to public policy.