Does Bundling Workforce Services with Medicaid Expansion Improve Employment Outcomes? Evidence from Montana's HELP-Link Program

Abstract

This paper evaluates whether integrating workforce development services with Medicaid expansion produces larger employment gains than coverage expansion alone. We exploit Montana's unique Health and Economic Livelihood Partnership (HELP) Act of 2015, which combined Medicaid expansion with the HELP-Link workforce program—a distinctive policy bundle not replicated in other expansion states. Using a triple-difference design that compares Medicaid-eligible adults to near-eligible adults in Montana versus control states (Colorado, Nevada, New Mexico) before and after HELP-Link implementation in 2016, we find that Montana's integrated approach increased employment among the Medicaid-eligible population by approximately 4.9 percentage points relative to Medicaid expansion alone. Effects are concentrated among prime-age adults (25-54) and those without disabilities, with larger gains for women and older workers. These findings suggest that pairing health coverage with active labor market interventions may enhance the employment effects of Medicaid expansion, with implications for ongoing debates about work requirements versus work supports in public insurance programs. However, the limited number of clusters (4 states) warrants caution in interpretation. \vspace{0.5cm} Keywords: Medicaid expansion, workforce development, employment, difference-in-differences, Montana \vspace{0.3cm} JEL Classification: I13, I18, J21, J68