Medicaid Work Requirements
The GOP House is looking to impose work requirements as a condition of Medicaid eligibility. This makes no sense as policy, but they believe it has political appeal that gives them cover and will help fund President’s tax cuts, primarily benefiting the wealthy. It’s basically adding a lot of red tape, added administrative costs and complexity that then serve as a deterrent to working poor people completing and retaining successful Medicaid enrollment.
Medicaid is a health program; it doesn’t pay for your groceries, your childcare, your transportation, your rent, your school, your clothing or your utilities. It does pay hospitals, doctors, pharmacies, nursing homes, health plans and community clinics and thus helps pay the rent and groceries for health care employees. You can enroll at any time in Medicaid.
Typically work requirements are associated with cash assistance programs such as unemployment, welfare, and food stamps. They are perceived as necessary in those programs as an incentive to go to work. However, the strongest work incentives in many of those programs are the very low level of cash assistance benefits which make work far more attractive when you can get a good job.
The Commonwealth Fund reviewed all the studies and outcomes of Medicaid work requirements and came to the following conclusions:
· Between 4.6 million and 5.2 million Americans would lose coverage
· Federal funds to the states would be reduced between $33 and $46 billion
· States would lose between 332,000 and 449,000 jobs, and $3.2 to $4.4 billion in state and local tax revenues
· About 1.1 million Californians would lose their coverage; the state would lose between $7 and $10 billion in federal revenues, and between 63,000 and 88,000 Californians would lose their jobs, primarily in the health sector, but in retail and construction as well. https://www.commonwealthfund.org/publications/issue-briefs/2025/may/medicaid-work-requirements-job-losses-harm-states
Georgia tried an experimental Medicaid work requirements program, called Pathways to Coverage; it hardly enrolled anyone because of its administrative complexity. https://www.cbpp.org/blog/georgias-medicaid-experiment-is-the-latest-to-show-work-requirements-restrict-health-care It was very expensive for the 5,500 who enrolled out of 250,000 potentially eligible, and only 36% of the program expenditures went for the costs of health care, the rest was on administrative costs and consultants.
Arkansas tried an experimental Medicaid work requirement program with a waiver from the first Trump Administration. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00538 It showed that people lost coverage, had increased medical debt, didn’t take medications, and delayed seeking needed care. There was no increase in employment.
New Hampshire is making a second attempt to impose a Medicaid work requirement. https://newhampshirebulletin.com/2025/03/12/republicans-push-medicaid-work-requirements-through-the-new-hampshire-senate/ It failed before when people were losing coverage solely due to the excessive administrative complexities they faced, such that the state’s GOP Governor pulled the plug on the work requirements.