C16-02 Medicaid Work Requirements Threaten Coverage for 2 Million Adults With Asthma

Introduction The One Big Beautiful Bill Act established Medicaid work requirements for beneficiaries in the 40 states (and D.C.) who expanded Medicaid under the Affordable Care Act, requiring them to report 80 hours of work or community engagement per month to maintain coverage. There is now growing momentum to extend work requirements to all Medicaid beneficiaries nationwide with supporters contending that many “able-bodied” beneficiaries choose not to work. However, little is known about the functional status of this population -- particularly among adults with asthma, which is the most prevalent pulmonary condition among non-elderly adult Medicaid enrollees, carries high morbidity, and is especially susceptible to changes in healthcare access. Therefore, this study characterized health and functional status of adults with asthma who would be at risk of Medicaid disenrollment if work requirements are instated nationally. Methods Using 2022-2023 Medical Expenditure Panel Survey data, we defined our study population as adults aged 19-64 who report having asthma. We excluded adults enrolled in Medicare or receiving Supplemental Security Income. Our primary outcomes were composite measures for physical health, mental health, and functional impairment. We compared outcomes between adults with asthma not meeting work requirements of 20 hours/week (at risk of disenrollment) to adults with asthma who are meeting work requirements using Rao-Schott Chi-square tests. Results The annual weighted population of Medicaid beneficiaries age 19-64 with asthma was 3,534,002 (mean age 36.6 years, 65.7% female). Of this population, 61.2% or 2,161,914 (+/- SE 145,869) beneficiaries would not meet work requirements if implemented nationwide and would be at risk of disenrollment. Among them, 55.9% used a daily asthma medication, 65.8% used a rescue inhaler in the last 3 months, and 48.0% reported an asthma exacerbation in the last year. In addition, 34.8% (95% CI, 26.5%-43.2%) reported poor physical health and 35.8% (95% CI, 24.7%-46.9%) reported poor mental health. Rates of poor physical and mental health were substantially higher in beneficiaries not meeting work requirements compared to their counterparts meeting work requirements. These beneficiaries also reported higher levels of impairment across all measures of physical and neuropsychological functional status as well as in independent functioning. (Figure 1). Conclusions Over 2 million Medicaid beneficiaries with significant asthma-related health needs will be at risk of disenrollment if work requirements are extended nationally. These beneficiaries have significantly higher rates of physical, mental, and functional impairment that fall short of formal disability yet likely limit their ability to work.