For a few years, Eric Wunderlin’s well being points made it arduous to seek out steady employment.

Struggling to handle despair and diabetes, Wunderlin labored part-time, minimum-wage retail jobs round Dayton, Ohio, making so little that he stated he typically had to decide on between paying hire and shopping for meals.

However in 2018, his CareSource Medicaid well being plan provided him assist getting a job. It related him to a life coach, who helped him discover full-time work with well being advantages. Now, he works for a nonprofit social service company, a job he stated has given him sufficient monetary stability to plan a European trip subsequent yr.

“I really feel like an actual individual and I can go do issues,” stated Wunderlin, 42. “I really feel like I pulled myself out of that hunch.”

Republicans in Congress and several other states, together with Ohio, Iowa and Montana, are pushing to implement work necessities for nondisabled adults, arguing {that a} mandate would encourage enrollees to seek out jobs. And for Republicans pushing to require Medicaid enrollees to work, Wunderlin’s story may very well be held up as proof that authorities well being protection might help individuals discover employment and, in the end, scale back their want for public help.

But his expertise is uncommon. Medicaid usually doesn’t provide such assist, and when states do attempt to assist, such efforts are restricted.

And opponents level out that almost all Medicaid recipients have already got jobs and say such a mandate would solely kick eligible individuals off Medicaid, somewhat than enhance their financial prospects. Practically two-thirds of Medicaid enrollees work, with many of the relaxation appearing as caregivers, going to highschool, or unable to carry a job as a result of incapacity or sickness, in accordance with KFF, a well being info nonprofit that features KFF Well being Information.

Current efforts to assist Medicaid recipients get a job have seen restricted success as a result of there’s not plenty of “room to maneuver the needle,” stated Ben Sommers, a professor of well being care economics on the Harvard T.H. Chan Faculty of Public Well being. Most Medicaid enrollees already work — simply not in jobs with well being advantages, he stated.

“The continuing argument that some people make is that there are lots of people freeloading in Medicaid,” he stated. “That is simply not supported by the proof.”

Utilizing well being care packages to encourage work

The GOP-controlled Congress might permit or require states to implement a Medicaid work requirement as a part of revamping and downsizing Medicaid. The primary Trump administration inspired these work mandates, however many have been struck down by federal judges who stated they have been unlawful beneath federal regulation.

Coverage specialists and state officers say extra consideration ought to be paid to investments which have helped individuals discover higher jobs — from customized life teaching to, in some circumstances, well being plans straight hiring enrollees.

They argue that work necessities alone should not sufficient. “The transfer to financial mobility requires a ladder, not a stick,” stated Farah Khan, a fellow with the Brookings Establishment, a nonpartisan suppose tank.

Whereas Medicaid work necessities have been debated for many years, the difficulty has change into extra heated as 40 states and Washington, D.C., have expanded Medicaid eligibility beneath the Reasonably priced Care Act to the overwhelming majority of low-income adults. Greater than 20 million adults have gained protection because of this — however Republicans are actually contemplating eliminating the billions in additional federal funding that helped states lengthen eligibility past teams together with many kids, pregnant ladies and disabled individuals.

Solely Georgia and Arkansas have applied mandates that some Medicaid enrollees work, volunteer, go to highschool, or enroll in job coaching. However a research Sommers co-authored confirmed no proof that work necessities in Arkansas’ program led to extra individuals working, partially as a result of most of those that might work already have been.

In Arkansas, greater than 18,000 individuals misplaced protection beneath the state’s requirement earlier than the coverage was suspended by a federal choose in 2019 after lower than a yr. Those that misplaced their Medicaid well being care reported being unaware or confused about methods to report work hours. Since 2023, Arkansas has been giving Medicaid well being plans monetary incentives to assist enrollees prepare for jobs, however to date few have taken benefit.

Some plans, together with Arkansas Blue Cross and Blue Defend’s, provide members $25 to $65 to finish a “profession readiness” certificates. In 2024, some Arkansas well being plans provided enrollees academic movies about subjects together with taxes and cryptocurrency.

Well being plans do not have an incentive to assist somebody discover a better-paying job, as a result of that might imply dropping a buyer in the event that they then make an excessive amount of to qualify for Medicaid, stated Karin VanZant, a vp at Clearlink Companions, a well being care consulting firm.

Relatively than providing incentives for offering job coaching, some states, corresponding to California and Ohio, require the insurance coverage firms that run Medicaid to assist enrollees discover work.

In Montana, the place some lawmakers are pushing to implement work necessities, a promising non-obligatory program almost collapsed after state lawmakers required or not it’s outsourced to personal contractors.

Throughout the program’s first three years, the state paired 32,000 Medicaid enrollees with present federally funded job coaching packages. Most had greater wages a yr after beginning coaching, the state discovered.

However enrollment has plummeted to simply 11 individuals, in accordance with the newest knowledge supplied by the state’s labor division.

Sarah Swanson, who heads the division, stated a number of of the nonprofit contractors that ran this system shuttered. “There was no actual half on this for us to ship direct providers to the oldsters that walked via our door,” she stated. The state hopes to revive job coaching by permitting the division to work alongside contractors to succeed in extra individuals.

The hunt for outcomes

State officers say they do not have a lot knowledge to trace the effectiveness of present job packages provided by Medicaid plans.

Stephanie O’Grady, a spokesperson for the Ohio Division of Medicaid, stated the state doesn’t monitor outcomes as a result of “the well being plans should not employment companies.”

Officers with CareSource, which operates Medicaid plans in a number of states, say it has about 2,300 Medicaid and ACA market enrollees in its JobConnect program — about 1,400 in Ohio, 500 in Georgia and 400 in Indiana.

This system connects job seekers with a life coach who counsels them on expertise corresponding to “exhibiting up on time, dressing the half for interviews, and promoting your self through the interview,” stated Jesse Reed, CareSource’s director of life providers in Ohio.

Since 2023, about 800 individuals have discovered jobs via this system, in accordance with Josh Boynton, a senior vp at CareSource. The well being plan itself has employed 29 Medicaid enrollees into customer support, pharmacy and different positions — almost all full time with advantages, he stated.

In 2022, California began providing nontraditional well being advantages via Medicaid — together with assist discovering jobs — for enrollees experiencing homelessness or critical psychological sickness, or who’re in any other case vulnerable to avoidable emergency room care. As of September, it had served almost 280,000 enrollees, however the state does not have knowledge on what number of turned employed.

The College of Pittsburgh Medical Middle, which is among the many largest non-public employers in Pennsylvania, operating each a sprawling hospital system and a Medicaid plan, has employed over 10,000 of its Medicaid enrollees since 2021 via its coaching and assist providers. Amongst different jobs, they took positions as warehouse employees, customer support representatives and medical assistants.

The overwhelming majority left low-paying jobs for full-time positions with well being advantages, stated Dan LaVallee, a senior director of UPMC Well being Plan’s Middle for Social Affect. “Our Pathways to Work program is a mannequin for the nation,” he stated.

Josh Archambault, a senior fellow with the conservative Cicero Institute, stated Medicaid ought to deal with enhancing the monetary well being of these enrolled.

Whereas the primary Trump administration permitted Medicaid work necessities in 13 states, the Biden administration or federal judges blocked all besides Georgia’s.

“I do not suppose states have been given ample probability to experiment and check out to determine what works,” Archambault stated.

KFF Well being Information senior correspondent Angela Hart contributed to this report.