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Though the federal courts have yet to determine the fundamental legality of Medicaid work requirements, key informants and focus group participants identified several lessons learned and potential strategies to address the challenges surrounding Arkansas’s Medicaid work requirements—strategies that could help reduce coverage losses and promote individuals’ ability to work—including expanding the scope, depth, and intensity of community-based outreach and education efforts; expanding and simplifying the means and methods available for reporting work and community engagement activities; and increasing funding for work support agencies and infrastructure so they have the expanded capacity to help Medicaid enrollees gain employment. However, many stakeholders we spoke with believed that beneficiaries would face barriers to compliance even if these strategies were implemented. (Hill and Burroughs, 10/3)

Nearly half (46%) of Kentuckians enrolled in Medicaid said they had not heard anything about the state’s plans for a new work requirement. Minorities and those with less education were less likely to have heard about the policy. Eighty percent of low-income Kentuckians reported they were unsure whether the requirement was in effect, and only 8 percent knew the policy was not in effect. Nearly all adults in Kentucky Medicaid surveyed were already working or otherwise meeting the state’s proposed work requirements. The survey found similar results in Arkansas, which implemented work requirements in 2018 and experienced higher uninsured rates, no increase in employment, and substantial confusion. (Madubuonwu, Chen and Sommers, 9/27)

This year is the first in which Americans no longer face a tax penalty for not having health insurance: Congress repealed the penalty, effective 2019. At the time of the survey, three states — Massachusetts New Jersey, and Vermont — as well as the District of Columbia had passed legislation establishing an individual mandate. Among survey respondents living outside these states, 54 percent were aware of the change in federal law, including 55 percent of insured adults and 48 percent of uninsured adults. Among uninsured adults who were aware the penalty was no longer in effect, 24 percent said they chose not to get health insurance this year because of the change. This translates into about 11 percent of all uninsured adults. (Collins and Gunja, 9/26)

Nearly 1 in 10 Medicare enrollees 65 years and older and 4 in 10 enrollees younger than 65 years experience food insecurity, suggesting both poor eating patterns that threaten health and inadequate access to other basic needs. Our estimates for older Americans are consistent with earlier reporting. Long-term disabled enrollees are far less studied. The pervasive food insecurity across segments within the disabled group is striking. We found disabled status, lower incomes, Medicaid dual enrollment, chronic condition burden, depression, and anxiety to be distinct factors. However, our cross-sectional analyses cannot establish causality. These findings highlight the appropriateness of the Centers for Medicare & Medicaid Services intensifying focus on social determinants of health, exemplified by the Accountable Heath Communities model,6 which targets dual enrollees, and the recent expansion of allowable supplemental benefits in Medicare Advantage plans. (Madden, Shetty, Zhang et al, 9/30)