A new blog post on Health Affairs by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at Milken Institute School of Public Health examines the potential impact of Kentucky’s Medicaid work requirements on community health centers and the patients they serve. Authors Peter Shin, Jessica Sharac and Sara Rosenbaum utilized published estimates of the Kentucky population subject to work requirements from the Urban Institute’s analysis of the 2016 American Community Survey and Supplemental Nutrition Assistance Program (SNAP) beneficiaries, and applied these estimates to the patient profile of Kentucky’s twenty-three community health centers. They found that 28,900 to 49,200 Medicaid health center patients would be at risk of losing coverage as a result of the state’s work requirements. This translates to 14% to 24% of health center Medicaid patients – or as many as one in four – and a potential loss of $22 million to $37 million in health center revenue, or 6% to 11% of the total operating revenue for Kentucky’s community health centers in 2016. The implications of this are enormous, and could lead to significant service and staffing losses because of the important role of Medicaid in health center financing. The authors further estimate that Kentucky’s health centers would need to reduce staff by 400-700 positions, and as a result, would serve 60,000 to 102,000 fewer patients.

A related blog by Milken Institute SPH colleagues Erin Brantley and Leighton Ku, also posted on Health Affairs, looks at the experience of imposing work requirements on working-age adult SNAP beneficiaries in several states to project the impact of the new rules in Kentucky. Their analysis suggests that Medicaid declines in Kentucky could occur faster and be far greater than the state’s projections provided to CMS, with as many as 175,000 to 297,500 people losing Medicaid coverage in the first year.

With other states in the process of seeking approval to impose work requirements on Medicaid beneficiaries, these state-specific analyses suggest that the consequences could be far-reaching and long term, dramatically increasing the number of people who are uninsured and reversing the gains achieved through Medicaid expansion.

These findings are summarized in the amicus curiae brief submitted by 43 public health scholars including 8 Deans and Associate Deans of schools of public health, public policy and administration, in support of Stewart v. Azar, a lawsuit that challenges the approval of the Kentucky Medicaid demonstration and the federal government’s legal authority to launch Medicaid work demonstrations. As detailed in the friend of the court brief, the work requirements run counter to the very intent of the Medicaid program. For community health centers and the people they serve, the potential damage to access and ultimately, to health itself, looms large.