Hurdles cause eligible people to drop Medicaid

In 2003, Washington state was facing a budget crisis and wanted to reduce spending on Medicaid. Instead of requiring people to establish their eligibility annually, the legislature began requiring them to do so twice a year, and it added some paperwork. It worked: Enrollment in the health insurance program fell by more than 40,000 children in a year.

In the early 2000s, Louisiana wanted to maximize the number of eligible children who signed up for coverage, so officials simplified the sign-up process. It also worked: Enrollment surged, and the number of administrative cancellations fell by 20 percentage points.

In 2006, Congress asked states to verify the citizenship of beneficiaries by seeking their birth certificates. Across the country, children’s Medicaid enrollment dropped, despite scant evidence that ineligible children had been signed up. That policy was reversed as part of the Affordable Care Act in 2010.

The Trump administration’s decision to approve a first-of-its-kind work requirement for Kentucky’s Medicaid program earlier this month has inspired concern that the program will leave behind Medicaid beneficiaries who are unable to find or keep work. But a large body of social science suggests that the mere requirement of documenting work hours is likely to cause many eligible people to lose coverage, too.

“Without being tremendously well organized, it can be easy to fail,” said Donald Moynihan, a professor of public affairs at the University of Wisconsin-madison,