Does Employment Lead to Improved Health? New Research Review Finds Mixed Evidence with Caveats that Could Impact Applicability to Medicaid Work Requirements

With nearly a dozen states seeking or implementing waivers to add work requirements for some Medicaid beneficiaries, a central question is whether such policies promote health and therefore promote the goals of the Medicaid program.

A new Kaiser Family Foundation report reviews research about the relationship between work and health and finds only limited evidence that employment improves health, with some studies showing a positive impact and others showing no relationship at all or only limited effects. The review does find strong evidence of an association between unemployment and poorer health outcomes.

While unemployment is almost universally a negative experience and linked to poor outcomes, especially for mental health, employment can be positive or negative depending on the nature and quality of work, including its stability, hours, pay and stress levels. Low-quality, unstable and poorly paid jobs lead to or are associated with adverse health effects, suggesting that all jobs should not be expected to have similar effects on workers’ health.

The report also discusses other limitations and conclusions to consider in applying research findings to Medicaid work requirements, such as the “healthy worker” effect of healthier people being more likely to work, limits on applying population-wide studies to the low-income Medicaid population, and the potential health effects of losing health coverage as a result of work requirements.

The new report examines past research on the relationship between work and health and its implications for Medicaid work requirements. It focuses primarily on findings from other literature or systematic reviews rather than individual studies and includes studies cited in the federal government’s policy documents on work requirements in the Medicaid program as well as other research.