Congress is considering a budget bill that includes a proposal to require certain Medicaid recipients to work, volunteer, attend school, or participate in job training for at least 80 hours per month to maintain their health coverage. The work requirement would apply to adults under 65 who do not have children or a disability. Supporters argue that the mandate would encourage able-bodied enrollees to work and eventually move off Medicaid, preserving the program for the most vulnerable Americans.
However, many Medicaid recipients and their advocates fear millions of people could lose coverage, including those who already work or qualify for an exemption but might get stuck in red tape. According to a preliminary analysis by the Congressional Budget Office, an estimated 4.8 million Medicaid recipients could lose coverage over 10 years due to the work mandate. This figure could grow due to last-minute changes to the House bill that accelerated the start date of the requirement.
Many adults with Medicaid coverage already have jobs, though estimates vary. KFF, a nonpartisan health policy research group, found that 38% of adult enrollees had full-time jobs in 2023, most of them year-round.
Medicaid work requirements debated
About 20% worked part-time, and another 31% did not work due to being caregivers, in school, or having an illness or disability—all potential exemptions from the work requirements. “Most people are already doing what could qualify them for an exemption,” said Michael Karpman, principal research associate at the Urban Institute. “But navigating the reporting process can be difficult.”
In Arkansas, during a temporary period when work requirements were implemented, over 18,000 Medicaid enrollees lost coverage.
Many beneficiaries didn’t understand the requirements or realize they applied to them, and others had trouble using the online reporting portal. Katrina Falkner from Chicago knows firsthand the challenges of navigating Medicaid’s bureaucracy. She was disenrolled from Medicaid in 2023 after the state lost her paperwork, leading to a prolonged period without insurance.
“If I lost my Medicaid, it would cause me a whole lot of struggles,” said Falkner, who suffers from asthma and other conditions. The Senate is expected to make changes to the legislation, but any adjustments to its Medicaid provisions remain uncertain. As lawmakers debate the merits of work requirements tied to Medicaid, the experiences of states that have implemented similar programs will likely inform national policies.