How Will New Federal Requirements Affect Medicaid Expansion Enrollees in the Fourth District

Introduction

Since the passage of the Affordable Care Act (ACA), which allowed states to expand Medicaid eligibility to more low-income individuals, enrollment in the program has grown nationwide, while the US uninsured rate has fallen to a historical low.¹The same is largely true in the Fourth District, which comprises Ohio, eastern Kentucky, western Pennsylvania, and the northern panhandle of West Virginia, as all these states were early adopters of the expansion. In this District Data Brief, I examine current Medicaid expansion enrollment in Fourth District states and assess the impact of the Medicaid expansion on uninsured rates across the District and many of its subregions. I then examine the possible effects of a new federal community engagement requirement. Under this requirement, individuals who became eligible for Medicaid coverage because of the expansion will need to meet certain work, educational, or community service obligations to maintain their eligibility. The existing research about similar requirements shows that these policies may impact the labor force participation and hours worked of affected individuals. Some studies also conclude that policies like the federal one can affect the household finances of individuals who are disenrolled from Medicaid because of noncompliance with the requirement. As a result, this new requirement could ultimately have an impact on the labor market and some households' finances in the Fourth District.