Work Reporting Requirements Don’t Work: An in-depth look as Idaho moves closer to adding costly red tape to Medicaid

As Republican leaders in Washington prepare legislation to make deep cuts to Medicaid that will cause millions of people to lose their health coverage, some states are attempting to recycle failed policies that will achieve the same result. For example, the Idaho legislature passed and Governor Brad Little recently signed a bill into law that seeks to impose work reporting requirements on low-income adults with Medicaid, once approved by the Trump administration.

Work reporting requirements for Medicaid is not new and is fueled by misinformation that people who have Medicaid coverage do not work. In reality, more than 92% of working age adults who rely on Medicaid for health coverage are workers, students, people with disabilities, people caring for young children, or people caring for sick or disabled family members.

Under the first Trump Administration, the Centers for Medicare and Medicaid Services (CMS) approved waivers in 13 states to allow for work reporting requirements. Courts eventually struck down the waivers because work requirements are contrary to the purpose of the Medicaid program and the Biden Administration eventually stopped approving additional waivers. But in the few states that implemented work reporting requirements, the impact was disastrous: in Arkansas, 25% of people subject to the requirement were disenrolled and in New Hampshire, 67% were projected to lose Medicaid coverage before these states were forced to stop their programs.

Beyond the coverage losses, work reporting requirements create an additional layer of bureaucratic red tape in which the burden of additional paperwork and layers of eligibility screening make it harder for working adults, caregivers, and people with disabilities to maintain their coverage. All of this bureaucracy has been extremely expensive for states implementing work requirements. Arkansas spent $24.1 million on work requirement administration in just 18 months, and Georgia's administrative costs for its work requirement program are over $58 million. The price tag is hard to justify for a program that is unlikely to improve health or employment. Instead, they cause the uninsured rate to skyrocket, and expose residents to medical debt. Furthermore, by driving up uncompensated care (the cost of medical services provided but not paid for), work reporting requirements threaten the financial stability of the clinics and hospitals on which we all rely.  For all this, researchers have found no evidence that Medicaid work requirements incentivize work.

Republican leaders in Congress are contemplating including a national Medicaid work reporting requirement in forthcoming budget reconciliation legislation as a way to cut hundreds of billions of dollars from the program to pay for extending tax cuts for wealthy Americans.

The Idaho legislation offers a glimpse at how this would play out in states. Under the bill, all non-disabled, non-elderly adults would be required to work or participate in a work/volunteer program for 20 hours or more per week or else lose Medicaid eligibility. Certain groups are exempt from the requirement, including individuals who are pregnant, caring for dependents, or participating in a drug addiction or alcohol treatment and rehabilitation program. Idaho's requirement, if approved by federal lawmakers, would impact the lives of over 93,000 Idahoans who qualify for the state's Medicaid expansion. Similar to what we see at the national level, more than half of Idahoans on Medicaid are already working, or would otherwise be exempt. It's a solution in search of a problem where there isn't one, and adding this red tape would create more problems.

Idaho previously estimated that 18% of Idahoans who gained access to Medicaid when it expanded - 16,300 people - would lose access to their health care due to these requirements. Idaho's legislation is a betrayal of those who voted in the 2024 elections for lower costs, including health care costs, because it will push thousands of people off of their Medicaid coverage. The people of Idaho already made their position here clear, when a 60% majority voted in 2018 to expand Medicaid to more Idahoans in need of affordable health care.

While other states are joining Idaho in exploring Medicaid work reporting requirements-including Iowa, Kansas and Montana - states that know better are heading in the opposite direction.

In January, Michigan repealed its law, reversing course after the state's previous experiment with work reporting requirements would have caused one-third of eligible Michiganders to lose coverage at a hefty price tag of least $68 million. By removing this onerous, unnecessary and unfair requirement, Michigan lawmakers have stopped wasteful government spending and removed red tape to ensure state residents keep the health coverage they need to stay healthy and working.

Congress, Idaho and other states considering these programs would do well to follow Michigan's lead and remove work reporting requirements from their agenda.

The bottom line: Work reporting requirements do not work.