Chronic Disease and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19

  1. Rodlescia S. Sneed
  2. Alexander Stubblefield
  3. Graham Gardner
  4. Tamara Jordan
  5. Briana Mezuk

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Abstract

As the COVID-19 pandemic wanes, states may reintroduce Medicaid work requirements to reduce enrollment. Using the Health and Retirement Study, we evaluated chronic disease burden among beneficiaries aged >50 (n=1460) who might be impacted by work requirements (i.e. working <20 hours per week). Seven of eight chronic conditions evaluated were associated with reduced workforce participation, including history of stroke (OR: 7.35; 95% CI: 2.98-18.14) and lung disease (OR: 4.39; 95% CI: 2.97-7.47). Those with more severe disease were also more likely to work fewer hours. Medicaid work requirements would likely have great impact on older beneficiaries with significant disease burden.

Key Points

  • Chronic disease linked to reduced work among older Medicaid beneficiaries.

  • Work requirements would greatly impact those aged >50 with chronic conditions.

  • Coverage loss would have negative implications for long-term disease management.

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  1. ScreenIT

    SciScore for 10.1101/2022.02.07.22270614: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableCovariates: Demographic variables included in all analyses were age (continuous variable), sex (male/female), education (no degree, high school diploma, GED [general educational development], two-year degree/some college, four-year degree, master’s degree, professional degree), race (Non-Hispanic White, Non-Hispanic Black, Hispanic, Non-Hispanic Other), and marital status (Married, Partnered & Unmarried, Separated,
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    Covariates: Demographic variables included in all analyses were age (continuous variable), sex (male/female), education (no degree, high school diploma, GED [general educational development], two-year degree/some college, four-year degree, master’s degree, professional degree), race (Non-Hispanic White, Non-Hispanic Black, Hispanic, Non-Hispanic Other), and marital status (Married, Partnered & Unmarried, Separated,
    Non-Hispanic White
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Further, among those who remain in the workforce, chronic disease has been strongly linked to limitations in individuals’ abilities to perform both the physical and psychosocial demands of work (Lerner et al., 2000). People with chronic health conditions report less productivity and more difficulty in performing physical work-related tasks (Jinnett et al., 2017). Additionally, individuals with chronic conditions face more workplace discrimination and less employer support than their counterparts (Siu et al., 2012). Limitations: This study is not without limitations. We utilized data from the 2016 HRS to evaluate associations between chronic disease and reduced workforce participation. These data were collected prior to the COVID-19 pandemic, which has had known impacts on both employment and Medicaid enrollment (Hinton et al., 2021). Consequently, our sample may not reflect the current population of adults aged >50 receiving Medicaid benefits. Despite this, our study still has a number of strengths. We utilized data from a population-based sample including more than 20,000 individual participants. This provided us with an adequate subsample of Medicaid beneficiaries over 50 to perform our analyses. Further, the Health and Retirement study includes a large battery of health-related information, which allowed us to characterize the health status of our sample in great detail.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.02.07.22270614v1 on medRxiv