Absence of conflict of interest
Citation
Highlights
- The study's objective was to examine the impact of work requirements for Medicaid recipients on public benefits receipt, employer benefits receipt, and employment.
- The study used a difference-in-differences design to compare changes in outcomes before and after the implementation of Arkansas’s Medicaid work requirement relative to comparison states. The authors used survey data and statistical models to compare differences between treatment and comparison group members.
- The study found that while work requirements were in effect, Medicaid coverage in Arkansas significantly decreased compared to states without work requirement policies.
- This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to work requirements for Medicaid recipients; other factors are likely to have contributed.
Features of the Study
This study used a difference-in-differences approach to examine the impact of Arkansas’s Medicaid work requirement policy on public benefits receipt, employer benefits receipt, and employment. Arkansas fully implemented the work requirement policy beginning in June 2018 and ending in April 2019. The Arkansas policy required Medicaid recipients (aged 30-49) to work 20 hours per week, engage in an equivalent amount of community activities, or submit an exception. To compare the differences in outcomes, study authors used states with similar economic and demographic profiles that did not implement the same work requirement policy as Arkansas during the time period; this included Louisiana, Texas, and Kentucky. Data were collected in 2016, 2018, and 2019 using telephone surveys. Low-income adults in the target age group were over sampled. The total sample included 8,661 Medicaid recipients, with 60 percent from Arkansas. Participants were asked to provide retrospective data to estimate employment status prior to the policy implementation. The authors used statistical models to examine if changes in employment and insurance coverage in Arkansas during the period of the policy were greater than the changes in the comparison states. The models controlled for sex, race, language, marital status, type of residence, and year.
Findings
Public benefits receipt
- The study found a significant relationship between work requirements for Medicaid recipients and a reduction in Medicaid coverage.
Employer benefits receipt
- The study did not find a significant relationship between work requirements for Medicaid recipients and employer benefits receipt.
Employment
- The study also did not find a significant relationship between work requirements for Medicaid recipients and employment.
Considerations for Interpreting the Findings
Because the analysis considered a policy operating in only one state, it is impossible to disentangle the effect of Arkansas’s Medicaid work requirement policy from the effect of the state itself; this is known as a confounding factor. For instance, there could have been other changes occurring at the state level at the same time that could also have affected the outcomes of interest. We cannot attribute the estimated effects with confidence to Arkansas’s Medicaid work requirement policy, and not to other factors. Also, the authors used statistical models with random effects for age groups in each state because of the longitudinal data used in the study. However, they did not report or perform a specification test to justify their use of random effects rather than fixed effects as required by the CLEAR guidelines. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs.
Causal Evidence Rating
This quality of causal evidence presented in this report is low because the policy was implemented in only one state presenting a confounding factor and the authors do not justify their use of random effects. This means we are not confident that the estimated effects are attributable to the work requirements for Medicaid recipients; other factors are likely to have contributed.