Physician Fadi Al Akhrass examines patient Gary Ryan in Pikeville, Kentucky, in 2015. Kentucky is one of seven states to receive approval from the Centers for Medicare and Medicaid Services to move forward with Medicaid work requirements. Photo by Jahi Chikwendiu, courtesy The Washington Post/Getty Images

Physician Fadi Al Akhrass examines patient Gary Ryan in Pikeville, Kentucky, in 2015. Kentucky is one of seven states to receive approval from the Centers for Medicare and Medicaid Services to move forward with Medicaid work requirements. Photo by Jahi Chikwendiu, courtesy The Washington Post/Getty Images

In January 2018, federal officials released guidance on instituting Medicaid work requirements — an unprecedented move for the low-income health program. A year later, work requirements are pending or approved in more than a dozen states, advocates are fighting the rules in court and thousands have lost health coverage.

“We don’t want to see this set as a precedent — for this to become the new normal,” Emily Beauregard, MPH, executive director of Kentucky Voices for Health, told The Nation’s Health. “(Work requirements) put greater burdens on low-income workers, many who will fall through the cracks, become uninsured, not be able to manage their health conditions and be less able to keep a job. To me, that’s not a pro-work policy.”

As of the new year, Kentucky was one of seven states — along with Arkansas, Indiana, Maine, Michigan, New Hampshire and Wisconsin — to receive approval from the Centers for Medicare and Medicaid Services to move forward with Medicaid work requirements. Another eight states — Alabama, Arizona, Mississippi, Ohio, Oklahoma, South Dakota, Utah and Virginia — were still waiting for CMS approval.

Work requirement proposals vary from state to state, targeting both Medicaid expansion and nonexpansion populations, but the overall gist is the same: to make Medicaid coverage for low-income adults — with the exception of pregnant women, people ages 65 and older, and those receiving disability benefits — contingent on meeting and reporting a certain number of work hours each month. In Arkansas, which was the first to begin Medicaid work requirements last summer, nearly 18,000 people had lost health coverage as of late 2018.

To continue reading this story from the February/March 2019 issue of The Nation’s Health, visit the newspaper online.