Medicaid Work Requirements Could Boot 36 Million People Off Their Health Coverage: Report

As right-wing lawmakers pursue imposing conditions on Americans' ability to access Medicaid and other social services, the Center on Budget and Policy Priorities this week published analysis warning that work requirements for Medicaid recipients could put 36 million Americans, or 44% of all Medicaid enrollees, at risk of losing their health insurance.

"Research shows that work requirements do not increase employment," according to the authors of the CBPP report, which was published on Wednesday. The authors argue that these types of requirements are based on the premise that Medicaid enrollees do not work, when data shows that they do.

"Nearly 2 in 3 adult Medicaid enrollees aged 19-64 already work, and most of the rest would likely not be explicitly subject to the requirement based on having a disability, caring for family members, or attending school," the report states.

The group estimates that of those 36 million people who could be impacted, 20 million are enrolled through the Affordable Care Act's Medicaid expansion.

While almost all Medicaid enrollees either work or would qualify for an exemption under most Medicaid work requirement proposals, according to CBPP, the report points to multiple past examples that indicate many enrollees still lose coverage with the imposition of work requirements due to "administrative burden and red tape."

For example, when Arkansas in 2018 temporarily implemented a policy that placed work requirements on Medicaid recipients, about 25% of enrollees subject to the requirements, some 18,000 people, lost coverage before a federal court paused the program seven months later.

As another example, New Hampshire implemented a short-lived Medicaid work requirement program in 2019 with more flexibility in reporting requirements and "more robust outreach efforts" in order to avoid Arkansas' mistakes, according to CBPP, but 2 in 3 enrollees who had to comply with the requirements "were likely to be disenrolled after just two months, amid reports of widespread confusion among enrollees about how to comply with the requirements."

The analysis—which the authors say is not an estimate of the number of people who will be impacted by a specific policy proposal—defines the population at risk of losing their coverage as adults between ages 19 and 64 who are not enrolled in Medicaid through disability pathways, i.e. a wider net of people than are specifically targeted in some recent GOP proposals.

The 36 million number is a larger group of enrollees compared to a previous CBPP estimate that was in response to a specific proposal whose work requirements would have targeted fewer people.

Multiple recent GOP proposals regarding Medicaid work requirements target "able-bodied" workers, though they vary in other specifics.

The far-right policy blueprint "Project 2025" calls for the Centers for Medicare and Medicaid Services to "clarify that states have the ability to adopt work incentives for able-bodied individuals" on Medicaid. And in late January congressional Republicans passed around a list of ideas for how to fund a bill full of GOP priorities that included imposing Medicaid work requirements for "able-bodied" adults without dependents, modeled after the Limit, Save, Grow Act, a bill passed by the House in 2023.

On Thursday, Sens. John Kennedy (R-La.) and Eric Schmitt (R-Mo.) reintroduced the Jobs and Opportunities for Medicaid Act, a bill that would require "able-bodied adults without dependents who receive Medicaid benefits to work or volunteer for at least 20 hours per week."

Because the Kennedy and Schmitt bill includes an exemption for adults with dependents, it would impact a smaller number of people than the CBPP's Thursday analysis. But still, as a general matter, "work requirements are simply another way to cut Medicaid," according to the authors of the analysis. Republicans' January list of cost cut options estimated that adding Medicaid work requirements along the lines of what was specified in the Limit, Save, Grow Act would yield $100 billion in 10-year savings.