Harmful Impacts of Medicaid Work Requirements

One of the most widely discussed changes in Medicaid policy is imposing a work requirement on people who rely on Medicaid for health insurance. The House Budget Committee has proposed a policy that "would restore the dignity of work by implementing work requirements for able-bodied adults without dependents to qualify for Medicaid coverage, as included in the House-passed Limit, Save, Grow Act (H.R. 2811). Certain populations would be exempted, such as pregnant women, primary caregivers of dependents, individuals with disabilities or health-related barriers to employment, and full-time students."

State-Level Evidence on Work Requirements

Similar policies have been enacted or are being considered in states and provide examples of how a policy could play out on the national level.

Georgia Pathways to Coverage Program (2023):

• In 2023, Georgia launched Pathways to Coverage, a limited Medicaid expansion program with work requirements.
• Only 7,000 people enrolled as of March 31, 2025-far below the state's 240,000 eligible population.
• Moreover, only 20% of the funding was spent on health services, with the remainder allocated to administrative and consulting costs.

Arkansas Work Requirements and Coverage Losses:

• In 2018, Arkansas implemented monthly 80-hour work requirements, which was terminated in 2019 when it was deemed unlawful.
• More than 18,000 people lost Medicaid coverage (28%) of the target population.

The primary reason for disenrollment was confusion and administrative barriers. See references Center on Budget and Policy Priorities and Urban Institute.

Early federal saving estimates from the Congressional Budget Office (CBO), based on applying Arkansas' work requirement nationwide, projected $109 billion in federal savings and 1.5 million people losing coverage. More recent projections using Georgia's approach show estimated savings rising to $260 billion with 2.5 million enrollees affected.

Nationally, most Medicaid enrollees work. Those who do not work are typically caregivers, students, or individuals facing employment barriers.

Nationally, most Medicaid enrollees work-about two-thirds of Medicaid enrollees already work and most work full-time. Those who do not work are typically caregivers, students, or individuals facing employment barriers (e.g., lack of job opportunities, transportation). Without work exceptions, work requirements could result in 44% of people enrolled in Medicaid losing coverage.

While Medicaid policies are evolving, evidence from states suggests that work requirements and funding reductions lead to major coverage losses, increased administrative costs, and worsened health outcomes. As policymakers debate these changes, it is essential to recognize that greater investment in primary care is the key to addressing chronic disease and ensuring healthy, productive communities.