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Medicaid work requirements are making a comeback-and they could have huge consequences for millions of Americans. A new proposal in Congress, introduced in February 2025, would tie Medicaid eligibility for some adults to work requirements, all part of a broader push to reduce federal spending and extend tax cuts.
While the idea of encouraging work sounds good on paper, the reality is a lot messier. Most adults on Medicaid are already working, or they're unable to work because of caregiving responsibilities, illness, or school. For those who do have jobs, they're often employed in industries like agriculture or service work, where health insurance isn't offered-or if it is, it's unaffordable.
A proven recipe for losing coverage
If Congress doesn't move forward, some states will still try to impose work rules through Medicaid waivers. We've seen how that plays out. When Arkansas put work requirements into place back in 2018, more than 18,000 people lost their coverage in less than a year, according to research from the Kaiser Family Foundation and New England Journal of Medicine.
The Congressional Budget Office (CBO) projects that a national work requirement could cause 1.5 million people to lose Medicaid each year, without increasing employment. In fact, CBO data from 2023 shows that similar policies would leave about 600,000 more Americansuninsured while saving $109 billion over a decade. But the savings come at a human cost: more people struggling without access to healthcare.
Confusion, costs, and care gaps
Work requirements aren't just tough on individuals-they're a bureaucratic nightmare for states too. The GAO found that some states spent up to $270 million just trying to set up systems to track work activities. Much of that money didn't go toward healthcare-it went toward paperwork, IT upgrades, and consulting fees.
Georgia's current "Pathways" program highlights the problem. Despite a $10.7 million ad blitz and $40 million in istrative spending, enrollment has fallen far short of expectations. Most eligible adults either didn't know about the program or couldn't meet the reporting demands.
Beyond the logistics, there's a deeper issue: Access to affordable healthcare is often what helps people stay employed. Research published in Health Affairs shows that good health improves a person's ability to keep a job. Medicaid offers vital coverage for mental health, addiction services, and chronic conditions-all key factors in helping people work and stay healthy.
As lawmakers revisit the idea of work requirements, the question remains: Is it really about getting people to work-or simply cutting costs, no matter the consequences?