Older people and those in poor health most likely to lose Medicaid due to work rules, study says; state's numbers differ

The Kentuckians most likely to lose their Medicaid coverage because of new work requirements "are older and in poor health while those most likely to keep their insurance are younger and in better condition," according to an Urban Institute analysis, reports Adam Beam of The Associated Press.

Based on census data, the institute figures that 357,000 Kentucky Medicaid beneficiaries won't qualify for one of the exemptions from the new rules, which will be phased in starting July 1. "Of those, 188,000 are not working and most at risk of losing coverage," Beam writes. "Their average age is 45, with 48 percent of them older than 50." He adds that 76 percent lack a car, household access to the internet or a high-school diploma; have serious health limitations; or live with someone who does.

State officials' estimates differ. They say 224,000 people will be covered by the work rules and 100,000 to 130,000 people will qualify for exemptions, such as being a full-time student or a primary caregiver. The study estimates the exempt number at 174,000 and says their average age is 34, and 85 percent are high-school graduates, reflecting those two major exemptions. "About 20 percent report one or more serious health limitations," Beam notes.

The different estimates may be driven by limitation of the study, which was funded by the Robert Wood Johnson Foundation. "The rules for work requirements apply to full-time students, but the data does not distinguish between full-time and part-time, so the study counted all students as exempt. That's likely an overestimate," Beam writes, "The work requirements also exempt pregnant women, a population not counted in the data."

Also, the work rules exempt the 'medically frail,' which the study could not count. "Kentucky's application to the federal government said this could include people with active cancer, aplastic anemia, blood clotting disorders, chronic alcohol or drug abuse, and mental illness," Beam reports. "But it's unclear how those rules will be applied. It's possible a number of people the study identified as not exempt from the work requirement would fall into one of those categories."

Beam adds, "The study also identified another group: about 169,000 people who would not be exempt from the work requirements but who already have a job. It would be easier for them to meet the requirements and not lose coverage. Of those, 36 percent reported they worked less than the required 80 hours per month. But working isn't the only way to fulfill the requirements. People can also participate in community service, attend school or take job training classes.

All three groups are short of access to high-speed internet, Beam notes: "That could make it difficult to document their compliance with the work requirement, since state officials want people to use a mobile-friendly website to track that data. But people can also log their hours by mailing in printed forms or by visiting county offices of the Department of Community Based Services."