The debate over Medicaid work requirements resurfaced as part of broader efforts to reduce federal spending on the program. In February, the U.S. House of Representatives introduced a draft bill that includes minimum work requirements for certain Medicaid enrollees. Supporters argue that these requirements can promote independence and improve health outcomes, but the reality is far more complex.
The Congressional Budget Office (CBO) estimates that implementing such work requirements could save the federal government up to $280 billion over a six-year period. Proponents argue that narrowing eligibility would allow states and the federal government to allocate resources more efficiently.
The bill still needs to pass the Senate. While many Republican senators support the measure, some have raised concerns about deep Medicaid cuts. Even if federal legislation doesn’t include work requirements, states can still pursue them through Medicaid demonstration waivers, which are programs that tie Medicaid coverage to work and reporting obligations.
The Reality on the Ground | In practice, these projected savings come at a cost. A CBO analysis found that despite a drop in federal spending, employment rates would not rise. Instead, the policy would likely result in more people becoming uninsured.
When Arkansas implemented Medicaid work requirements in 2018, over 18,000 people lost coverage in just a few months. The reason was not that they didn’t want to work, but rather that they failed to meet the reporting requirements. Many didn’t understand the new rules, lacked internet access, or got caught up in administrative hurdles. This case highlighted how such policies can push vulnerable people off Medicaid.
Most Medicaid recipients who can work already do. National data show that among adults under 65 who are not on Medicare or receiving other benefits, 92% are employed full-time and 64% are working part-time. Of those who are not working, most report valid reasons, such as caregiving responsibilities, illness, disability, or school or college enrollment. Only a small percentage (around 8%) cite retirement, inability to find work, or other reasons. It’s worth noting that many low-income workers also have physically demanding jobs that do not offer health insurance. Medicaid provides access to affordable care, helping them stay healthy and remain employed.
When working people lose coverage like this, they’re less likely to access preventive care, manage chronic conditions, and afford essential medication. This can lead to worsening health outcomes and greater strain on emergency departments and safety-net providers. Without supportive services like childcare, transportation, or job training, work requirements are unlikely to help people secure employment. Instead, they tend to create additional barriers, especially in communities where jobs are scarce, transportation is unreliable, and health disparities are already high.
While work requirements may reduce government spending, evidence shows they often cause more harm than good. Without adequate support systems, these policies risk cutting people off from essential care. Protecting access to Medicaid is crucial—not just for individuals, but for the health of entire communities.
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