80% of adults unfamiliar with Medicaid work requirements

Come January 2027, Medicaid work requirements will take effect, but most people aren't familiar with the provisions, according to a poll from the National Alliance on Mental Illness and Ipsos.

These findings indicate serious shortcomings in beneficiary communication and engagement, the survey authors said.

Medicaid work requirements are one of the many changes to Medicaid under the Trump Administration intended to reduce spending and root out fraud. The provisions require Medicaid beneficiaries over the age of 18 to report 80 hours of work or other community engagement, such as school or volunteer hours, to maintain their coverage. There are exemptions, such as for individuals who are medically frail, have caregiving duties or are veterans, among other things.

Still, the work requirements are set to affect 5.8 million Medicaid beneficiaries, according to HHS data. However, critics of the policy maintain that most people on Medicaid who can work already do, and that the work requirements will create bureaucratic barriers to affordable healthcare coverage.

Experts have called for better member engagement and education, stating that current Medicaid enrollees must be made aware of not only the requirements but also of the reporting obligations that come with them.

However, the NAMI-Ipsos poll showed that's not exactly happening.

According to the survey of over 2,000 U.S. adults, 80% of folks are unaware of Medicaid's community engagement requirements, which is the more formal term for the work requirements. Just under two-thirds (62%) are aware they exist, but only 18% are actually familiar with what the requirements entail.

What's more, the public doesn't know when work requirements are set to begin, with only 18% of respondents correctly identifying the January 2027 start date. Most (78%) of respondents said they did not know when the requirements went into effect.

There's also some confusion about who's exempt from work requirements, especially folks with serious mental illness.

There is a lot of ambiguity around who would or would not get a work requirement exemption, especially as it pertains to medically frail people. HHS has advised states that healthcare providers must periodically reassess folks with chronic illness to determine whether they qualify for a medical frailty exemption.

That medical frailty exemption is getting bogged down in the courts. At the end of July, a federal judge declined a request from states to hit pause on Medicaid work requirement implementation. As part of a lawsuit filed by 25 states and the District of Columbia, the states argued that the implementation directions -- particularly determining medical frailty -- will place an undue burden on states.

Healthcare providers agreed. In a comment letter to the CMS, the American College of Physicians said making decisions about medical frailty and a patient's ability to work goes beyond the scope of physicians' duties.

"Physicians are trained to diagnose and treat medical conditions -- not to conduct vocational or occupational assessments regarding an individual’s ability to satisfy government work reporting requirements," ACP wrote in the letter. "Requiring physicians to make these determinations extends beyond their clinical role while increasing administrative workload and reducing time available for patient care."

Defining medical frailty -- and creating a feasible system that enables providers to periodically determine a Medicaid enrollee's medical frailty -- remains a sticking point as the nation stares down the January 2027 implementation point.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.