System Strain Likely With Medicaid Work Requirements: William Schpero, PhD, MPhil, MPH

William Schpero, PhD, MPhil, MPH, from the Weill Cornell Graduate School of Medicine, explained that new responsibilities for state Medicaid offices will strain the system as they look toward implementing the Medicaid work requirements by 2027.

This transcript has been lightly edited for clarity; captions are auto-generated

Transcript

Could the system be stressed by the increase in paperwork related to Medicaid work requirements?

I've talked a lot with states that are, right now, heads-down trying to implement the systems [and] the changes they need to ensure their compliance with the law and with the expectation that they implement work requirements. I'm hearing across the board this is a Herculean task for them. They have to invest in really significant changes to their enrollment and eligibility systems, to their data infrastructure, to try to ensure that they know if someone is working or if someone is not and that they can do their best to automate a lot of the reporting requirements to reduce the administrative burden associated with being compliant with the law. They're investing a ton in IT infrastructure. They're also trying to staff up at a time when they face major challenges staffing in the wake of the pandemic. There are, I think, really huge burdens on states to really implement all the changes they need to make ahead of the start of work requirements on January 1, 2027.

This is a really short timeline for states. They have, effectively, a year to be compliant with the law. What further complicates this is, even though the states have the language of the law, the statutory language as outlined by Congress, the regulations that indicate very specifically what they need to do to be compliant won't be released by the federal government until next summer. Really, there are only 6 months that states have following the release of those regulations to ensure that they've done everything correctly by the letter of the law. I think the timeline, along with the large IT enrollment and eligibility and infrastructure-related changes states need to make, puts a real burden on them and it's going to get very difficult for them to ensure that no one falls through the cracks.