A new Republican proposal could bring major changes to Medicaid, the government-funded health program that supports millions of low-income Americans. Lawmakers are considering implementing work requirements, a policy that could result in widespread loss of coverage for those who rely on Medicaid for essential health care.
Supporters argue that work requirements would encourage employment and reduce federal spending. However, past research and real-world examples suggest that such policies could instead lead to massive coverage losses without significantly boosting workforce participation.
Work
Under the proposed policy, certain Medicaid recipients would need to prove they are working, actively looking for a job, or participating in an approved activity like job training to maintain their health coverage.
A bill introduced in early 2025 aims to enforce these requirements nationwide. If passed, all states would be required to comply or seek waivers to implement similar policies on their own.
A similar program in Arkansas led to over 18,000 people losing Medicaid coverage in less than a year. Many of those affected were already employed or qualified for exemptions but failed to navigate the complex reporting system. If implemented on a national scale, this issue could impact millions.
Who
Many Medicaid recipients already work, often in low-wage jobs that do not offer employer-sponsored health insurance.
According to data on non-disabled adults under age 65 receiving Medicaid:
- 92% are either employed, caring for dependents, attending school, or unable to work due to health limitations.
- The remaining 8% cite reasons such as retirement or difficulty finding employment.
Critics argue that rather than incentivizing employment, work requirements would create administrative barriers that remove coverage from people who need it most.
A Congressional Budget Office (CBO) report estimated that a national Medicaid work requirement could result in 1.5 million people losing coverage each year without increasing employment rates.
Financial
Proponents of work requirements claim they could reduce Medicaid spending, which currently costs taxpayers about $880 billion annually.
However, past attempts have shown that enforcing these policies can be costly.
- Arkansas’s work requirement program required significant administrative resources.
- Georgia’s current system has already cost over $40 million, with most funds going toward administration rather than actual health care.
Beyond financial costs, losing Medicaid coverage can have serious health and economic consequences. Studies show that access to affordable health care helps people maintain employment by managing chronic conditions and mental health issues. Without insurance, individuals are more likely to delay necessary care, leading to worse health outcomes and higher financial burdens.
Future
While Congress debates a national Medicaid work requirement, some states may attempt to implement their own policies through waivers. However, past legal battles over these requirements indicate that new measures could face court challenges.
With millions of lives and billions of dollars at stake, the future of Medicaid remains uncertain. The ongoing debate will determine whether work requirements become a nationwide policy or remain a controversial state-level experiment.
FAQs
What are Medicaid work requirements?
They require recipients to work or job search to keep benefits.
How many people could lose Medicaid coverage?
An estimated 1.5 million people could lose coverage annually.
Do most Medicaid recipients already work?
Yes, 92% are employed, caregivers, students, or have health limits.
Has this policy been tried before?
Yes, Arkansas implemented it, causing 18,000 people to lose coverage.
Will states be able to set their own policies?
States may seek waivers, but legal challenges are likely.
