A growing number of states seek to establish work requirements in their Medicaid programs.  Using pooled data from the September 2018 and March 2019 rounds of the Health Reform Monitoring Survey, this study assesses potential barriers facing Medicaid enrollees in meeting these requirements through employment on a sustained basis. 

Compared with privately insured adults, Medicaid enrollees who would potentially be subject to work requirements are more likely to face employment barriers, including low educational attainment, health problems, limited transportation and internet access, criminal records, and residence in high-unemployment or high-poverty neighborhoods.  Likely reflecting these barriers, fewer than 1 in 6 potentially non-exempt Medicaid enrollees reported working at least 20 hours per week for all or nearly all weeks in the past year, compared with over 3 in 5 privately insured adults.  Half of nonexempt Medicaid enrollees reported issues related to the labor market or nature of employment (e.g., difficulty finding work, restricted work schedules) as reasons for not working more, and over one-quarter reported health reasons.

These work patterns and employment barriers underscore the risk of coverage losses under work requirements and suggest investments in education, training, other employment services, and work supports are needed to improve employment outcomes.