Risk Factors for Medicaid Disenrollment in the Era of Work Requirements: Evidence from Four Southern States

Abstract

Objective: To identify risk factors for Medicaid disenrollment after the implementation of Arkansas’s work requirements. Methods: Using a 2018 telephone survey of 1,208 low-income adults in Arkansas (expansion state with work requirements implemented in June 2018), Kentucky (expansion state with proposed work requirements blocked by a federal court), Louisiana (expansion state without work requirements), and Texas (non-expansion state), we assessed Medicaid disenrollment rates among those ages 30-49, the age group targeted by Arkansas’s policy. We assessed risk factors for disenrollment and post-disenrollment insurance status. Results: The Medicaid disenrollment rate was highest in Texas at 12.8 percent, followed by Arkansas at 10.5 percent, Kentucky at 5.8 percent, and Louisiana at 2.8 percent. Over half of those who disenrolled in Texas and Arkansas became uninsured, compared to less than a quarter in Kentucky and Louisiana. In a multivariate linear regression model, Arkansas had significantly higher disenrollment compared to the three comparison states, while men and non-Hispanic Whites experienced higher disenrollment than women or racial minorities. In Arkansas, having a chronic condition was associated with higher disenrollment. Conclusions: As states continue to debate work requirements and coverage expansions in Medicaid, our findings provide useful insights to policymakers about which populations may be most vulnerable to losing Medicaid coverage.