Some states skip Medicaid hardship exemptions ahead of work rules
Missouri and Iowa will not use optional exemptions that could help some people keep Medicaid when new work rules start in January. The exemptions cover hospital stays, travel for care, disasters and high jobless rates. Missouri says it wants less paperwork, but critics say more people could lose care.
Some conservative states, including Missouri and Iowa, are choosing not to use optional exemptions meant to help low-income people keep Medicaid under new federal work requirements, The Guardian and the Missouri Independent reported.
Starting Jan. 1, 2027, adults ages 19 to 64 covered through Medicaid expansion will have to work, go to school or volunteer at least 80 hours a month to keep their coverage, the Missouri Independent reported. The federal law lets states offer exemptions for people who are in the hospital, travel for medical care or live in areas hit by disasters or high unemployment.
New York City has adopted the high-unemployment exemption for the Bronx, where about 200,000 residents would otherwise face the rules, The Guardian reported. But Missouri and Iowa are not taking it, even though some of their counties would qualify, according to research by the health policy group KFF.
Missouri's Department of Social Services says it wants to avoid "an additional, burdensome bureaucratic layer for participants," spokesperson Baylee Watts wrote to the Missouri Independent. The state says it will handle cases such as acute medical events through broader exemptions for caregivers and people who are "medically frail." About 344,669 Missourians were in the adult expansion group as of Sept. 25.
Advocates say that will leave some people out. "If you polled Medicaid participants and said to them, would you rather lose your healthcare or fill out a hardship form, 100% of them would likely choose to fill out the form," said Joel Ferber of Legal Services of Eastern Missouri, The Guardian reported.
Experts say politics may play a role. "If [state officials] are advocates of work requirements, they may feel like these work requirements should apply to everyone evenly," said Jennifer Tolbert of KFF. She said administrative burden could also be a factor.
Past experience points to coverage losses. When Arkansas added work requirements in 2018, more than 18,000 people lost coverage by year's end with no significant rise in jobs, The Guardian reported. "Historically, they don't encourage people to work," said Jacob Wallace of the Yale School of Public Health.
The Guardian said it had asked Missouri and Iowa officials for comment.
What we know: Missouri and Iowa are skipping optional hardship exemptions before work rules start Jan. 1, 2027.
What we don't: How many people in those states could lose coverage as a result.
Where outlets agree The Guardian and the Missouri Independent both report that Missouri will not use optional hardship exemptions to the new Medicaid work requirements.
Where they differ Missouri says skipping the exemptions cuts paperwork, while advocates say it will cost some people their coverage.