Year of Publication



Martin School of Public Policy and Administration

Date Available


Executive Summary

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements of Kentucky and Arkansas, and ranking each on a 1-5 scoring scale, 1 being least severe and 5 being the most, I use total enrollment data for Arkansas, Kentucky, and West Virginia, and I estimate the difference-in-differences of the percent of those enrolled divided by the state’s annual population between West Virginia, my control state, and Arkansas, my treatment state. After standardizing and then comparing Arkansas to West Virginia through difference-in-difference testing, I find a net drop in enrollment with substantial uncertainty associated with it, leading to the conclusion in the first step of this analysis showing that while Arkansas has more of a decrease post-treatment in Medicaid enrollment than West Virginia, much of it is likely due to other factors.

These states’ trends are similar enough to provide an effective comparison for Kentucky, however. I found that if Kentucky ever implements work requirements, the change due to work requirements alone will be a decrease in enrollment by 24,129 people, over and above the existing trend. The estimation of Kentucky with work requirements is based on the difference-in-differences estimation between Arkansas and West Virginia subtracted from Medicaid enrollment annual population in Kentucky from June 2018 to December of 2018. This analysis provides an estimation of what could happen to total Medicaid enrollment in Kentucky, and possibly other states, if work and community engagement requirements are implemented. Future studies will hopefully have more data available in order to construct a more valid study of the actual effect of work requirements in states that have implemented them in comparison with those that have not and do not plan to – in order to inform the states that plan to what will happen to their Medicaid enrollment. Future studies that ask this same or a similar research question should also take into account other factors affecting Medicaid enrollment to provide a better basis for their estimation in order to predict their effect on the state(s) in question.



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