Proposed Medicaid work requirements include some exceptions for individuals with mental health conditions and substance use disorders, but questions remain about how these exceptions would be implemented, according to a June 23 report from KFF.
In May, the House passed the “One Big Beautiful Bill,” a sweeping budget reconciliation package. The legislation includes nearly $800 million in cuts to Medicaid funding over 10 years.
The bill would implement requirements for able-bodied Medicaid beneficiaries 19 and older to complete 80 hours of work or other qualifying activities per month to receive benefits. The bill includes exemptions from work requirements for those with “disabling” mental disorders, and substance use disorders.
Here are five things to know:
- ACA expansion is the primary pathway to Medicaid eligibility for individuals with mental health and substance use disorders. Among Medicaid-covered adults with substance use disorder or opioid use disorder, 6 in 10 are eligible for Medicaid on the basis of income.
- The version of the bill passed by the House does not define which diagnoses constitute disabling mental disorders.
- Common behavioral health symptoms, including challenges with concentration, anxiety and difficulties managing stress, could make it more difficult for some individuals to report their work or exemption status.
- Mild and moderate mental health disorders can lead individuals to have gaps in employment, but these conditions may not qualify Medicaid beneficiaries for exemptions from the work requirement.
- Individuals with new or undiagnosed behavioral health conditions may struggle to maintain their Medicaid coverage without an official diagnosis.
In May, Chris Hunter, CEO of Franklin, Tenn.-based Acadia Healthcare, said he is optimistic work requirements will not affect most of the inpatient behavioral health providers’ patients.
“We continue to believe the patient populations that we serve, including some of the highest-acuity mental health issues in the country, are going to be relatively less impacted in terms of the risk of losing Medicaid access,” Mr. Hunter said.
Read KFF’s full report here.
