That’s because the U.S. is trending toward “community engagement” or work requirements to encourage employment and reduce federal spending. Medicaid eligibility is mostly income-based, with work requirements adding new conditions for adults. In doing so, up to 5 million adults could lose their Medicaid coverage as soon as 2026.
Take a closer look at how this could unfold, and develop your strategy to balance work requirements with genuine engagement for your members’ sake.
The One Big Beautiful Bill Act (OBBBA) introduces nationwide work requirements for able-bodied adults to receive Medicaid benefits. It requires childfree adults aged 19-64 without disabilities to meet community engagement requirements to prove they worked, volunteered or attended school for 80 hours per month to retain Medicaid coverage.
Efforts to modify Medicaid eligibility aren’t new. In a similar effort, the Limit, Save, Grow Act of 2023 proposed requiring adults aged 19-55 to report at least 80 hours per month of work activities for coverage. But that was then. The current bill appears to have some staying power, passing the House immediately upon review.
But what about situations that don’t fit the typical mold?
The OBBBA does have certain provisions in place, including alternatives to the above requirements and exemptions. For instance, students attending school at least half the time or earning an income equal to 80 hours at minimum wage, participants already meeting work requirements for TANF or SNAP, pregnant women, inmates of public institutions and individuals facing short-term hardships also qualify for Medicaid coverage.
The latest prerequisites stand to have a domino effect on both members and providers.
"... We remain concerned that many of the Medicaid and ACA savings provisions will have a significant and negative impact on the ability of eligible individuals to access and maintain coverage." —Bruce A. Scott, M.D., president, American Medical Association
“In practice, it generates most of its savings by setting up a series of bureaucratic traps that people who are rightly eligible for the program must navigate in order to keep their coverage and by shifting billions in costs to states.” —Margaret A. Murray, CEO, ACAP
Bottom line? Changes to Medicaid eligibility and work requirements risk coverage losses — especially if members don’t meet or understand the new requirements. The policy changes create real threats to treatment access for mental health, chronic disease management and lifesaving care. Many members will experience poor outcomes from care interruptions and lack of medication access. And the vast majority of such disruptions will be from a lack of clarity around the new process.
Work requirements in practice: Arkansas and New Hampshire briefly implemented Medicaid work requirements. Of eligible enrollees, data shows that 18,000 people lost coverage due to lack of awareness of work reporting requirements — not failure to meet work criteria.
The issue remains divisive across the health care community, as Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, illustrates in saying, “Work requirements are a blunt tool that creates costly administrative red tape and separates eligible people from health coverage they rightfully qualify for.”
But the risks are real for the health care community. Facilities and plans alike could immediately feel the sting of treating more uninsured patients because work requirements would likely raise the number of uninsured people.
This is a house of cards because these patients would drive up uncompensated care costs — which are already trending toward $6 billion per year — for hospitals. We’re talking more emergency room visits that would require providers to eat the costs of treating uninsured patients.
Between issues of health care literacy and access to proper care, Medicaid members are often ill-equipped to fully manage and engage in their health. Member engagement changes the game to ensure care equity.
Give members what they need to manage their health. Proactively engaging Medicaid members — from educating them about preventive care to providing pathways to care and helpful resources — keeps them informed so they seek right-fit treatments in their time of need and makes it easier to maintain their coverage.
And it doesn’t matter what policy climate we’re living in. Engagement is always important simply to deliver members the care and attention they deserve.
Fostering empathetic relationships with Medicaid members creates safe spaces for individuals to fully participate in their health, whether it’s with their doctor or in a peer support environment. Work closely with your members to break down barriers to care. Engaging with them just once helps to identify obstacles — whether it’s transportation access or impending work requirements— that may be standing in their way of pursuing adequate care.
You can’t force care on your members, but you can make it easier and more pleasant for them to open up and take the right steps. Just remember that each member is an individual, and effective engagement is unique to them. That said, a few do’s and don’ts can shape your approach.
Making a phone call just to be able to check a box is not the same as really getting to know Medicaid members. Surface-level interactions — such as a phone call or text — are just superficial engagement washing.
Which would you rather: Have someone ask how you are and genuinely want to hear your answer, or hear a casual, “What’s up?” that basically just means hello? True engagement means understanding members' unique needs and creating a line of communication between both sides to support new needs as they arise.
Are your Medicaid members aware of the new work requirements and how to comply? Maybe they just need help navigating care. Whichever the case, provide a combination of human and tech-based support advocates to help manage their coverage.
Give members who have lower health literacy or higher nonmedical drivers of health (NMDOH) risks a bit of extra TLC. As you boost engagement, use data to screen for and address NMDOH factors, such as transportation, housing and social isolation. In doing so, you can learn more about individual members and provide tailored resources to improve care access:
Loneliness continues to be a struggle of epidemic proportions in the U.S. But technology — especially with AI advancements — is uniquely positioned to fill in the gaps. Consider implementing tech-enabled solutions for your plan to foster engagement, social connection and trust. Just keep members in mind with these offerings:
“Care” doesn’t always equate to an office visit. It’s all the little things that ensure your members can maintain their health — medications and beyond. Begin with channel-specific communications to give each member personalized next steps for their health needs. And for those who need extra support, share information about telehealth and mail-order prescriptions to support care equity.
While they may cause disruption and elevated administrative lift, Medicaid work requirements serve as a timely trigger to improve member engagement. Failing to understand these requirements could jeopardize your plan’s ability to continue supporting members — and may cost them the coverage they are entitled to.
Improve your communication infrastructure and outreach practices for the long term. Pyx Health offers a winning combination of empathetic care coordinators and a user-friendly mobile app to engage meaningfully with your members and provide a trusted resource when new challenges arise. The solution helps members understand their health benefits, build self-care skills and connect with vital resources to improve health outcomes, member experience and health care costs.
Improve member engagement and ratings on core metrics with Pyx Health. Tour our Medicaid solutions today.