200,000 spared, but some states snub Medicaid exemption
New federal work requirements for Medicaid will come into effect on January 1, but some conservative states, such as Missouri and Iowa, are choosing not to use exemptions that could help low-income residents, potentially due to ideological opposition or administrative burdens
Some conservative states in the US are opting not to use Medicaid hardship exemptions, which could help low-income residents maintain their coverage under new federal work requirements.
New federal work requirements for Medicaid, set to come into effect on January 1, will require adults enrolled through the Affordable Care Act (ACA) Medicaid expansion to work, attend school, volunteer, or take part in another qualifying activity for at least 80 hours a month to maintain their coverage.
States like Missouri and Iowa are choosing not to take up the high-unemployment exemption for their residents, despite having counties that would qualify for this exemption. In contrast, New York City has adopted the high-unemployment exemption for the Bronx, where about 200,000 residents would have been subject to the new requirements.
The decision not to take up the hardship exemption may be due to ideological opposition or administrative burdens. States that adopt the hardship exemption must submit data to CMS on an ongoing basis and ensure their eligibility system can exempt or exclude people from work requirements based on where they live.
Experts, including Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, and Sarah H Gordon, associate professor at the Boston University School of Public Health, point to ideological opposition as a potential reason for states not taking up the hardship exemption.
## Why it matters The new federal work requirements for Medicaid could have significant implications for low-income individuals and families who rely on the program for healthcare coverage. The decision by some states not to use the hardship exemption could exacerbate the impact of these requirements, potentially leading to a loss of coverage for vulnerable populations. As the January 1 deadline approaches, it remains to be seen how these changes will play out and what effects they will have on Medicaid recipients across the US.
