DROPS IN ENROLLMENT EXPECTED

who is writing a book on the effects of administrative burdens.

Researchers have studied the ways complexity can reduce signups for workplace pension plans, participation in food stamps and turnout in elections, he noted. “These sorts of little barriers are ways in which humans get tripped up all the time when they’re trying to do something that might benefit them.”

Anyone who has ever forgotten to pay a bill on time, or struggled to assemble all the necessary forms of identification before heading to the DMV, is likely to sympathize with how administrative hurdles can stymie someone. But these may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access. There is also a lot of research about the Medicaid program, specifically, that shows that sign-ups fall when states make their program more complicated.

The Kentucky program will not just create a work requirement for some beneficiaries; it will set up a broader obstacle course of administrative rules. Many beneficiaries will be asked to pay monthly premiums to the state to retain their coverage, as little as $1 a month for some extremely poor families, who are unlikely to have bank accounts.

They will be asked to notify Medicaid officials any time their income changes. Their benefits could rise or fall depending on whether they get an annual checkup, or take a financial literacy course. Beneficiaries who fail to renew their coverage promptly at the end of a year will be locked out for as long as six months. Beneficiaries who are “medically frail” can get an exemption from the work requirement, but they will need to submit a doctor’s note.

Kentucky officials argue that the changes will give beneficiaries more dignity and promote personal responsibility. But they also estimate that around 100,000 fewer people will be enrolled in the program by the end of five years. There are about 1.3 million Medicaid recipients in Kentucky.

Medicaid premiums are not unprecedented, and they have been studied. The results have typically been reductions in enrollment.