Working For Medicaid

Kentucky wants its recipients to prove they’re not idle. Will that make them healthier?

- John Tozzi and Zachary Tracer

Kentucky is about to become the first state to impose a work rule for Medicaid. Ben Abell and Bree Pearsall worry about what it will mean for their business. The married couple raise lamb and grow 40 crops on a farm outside Louisville that Abell says is “minimally profitable.” They don’t have pay stubs or time sheets to document the hours they work. That could be a problem starting this summer, when the state will require Medicaid recipients to prove that they’re working or that they qualify under a handful of exemptions. The couple has been on Medicaid since their daughter was born in 2015. Although Pearsall, who’s pregnant with their second child, will probably be exempt from the requirements, Abell could find his coverage at risk. Paying for private insurance would mean “we’d have less to invest in growing the business,” he says.

Tightening access to Medicaid has been a longheld goal of conservatives. The 53-year-old state and federal partnership provides insurance to 72 million low-income Americans and, at a cost of $586 billion, accounts for 17 percent of all health spending in the U.S. On Jan. 11 the Trump administration gave states authority to begin adding “community engagement” requirements such as work, volunteering, or job training for nondisabled adult recipients. The next day it approved Kentucky’s bid to do so, which had been pending since 2016.