What we're talking about
Work requirements, also called community engagement requirements, are additional eligibility conditions that mandate Medicaid enrollees to work or engage in work-related or community service activities for a minimum number of hours. Policies vary from state to state, but most would require 80 hours per month of qualifying activities, as well as some form of reporting in order to maintain coverage. Many proposals would include exemptions for certain groups, though they may not be automatically granted to everyone who would qualify (Coleman & Federman, 2025).
MYTH: Work requirements increase the workforce by targeting those who are able to work but choose to rely on the government.
FACT: The majority of adults on Medicaid are already working, and there is no evidence that work requirements increase workforce participation.
Supporters of Medicaid work requirements often overstate the number of enrollees who don’t work but are able to. In reality, the majority of adult enrollees are already working: 64% work full-time or part-time. Another 28% are caregivers, are ill or disabled, or are in school – conditions that could qualify for an exemption. Just 8% of adult enrollees reported not working, due to reasons including retirement and being unable to find work (Lukens, 2024).
Additionally, there is no evidence that a work requirement actually has a positive effect on the workforce. Arkansas implemented a Medicaid work requirement from June 2018 to March 2019. During this time, over 95% of the beneficiaries ages 30-49 already met the requirement or qualified for an exemption, and there were no significant changes to employment (Sommers et al., 2020).
MYTH: Work requirements provide a necessary incentive to work.
FACT: Work requirements do not address actual barriers to employment, but instead make it even harder to engage in work-related activities.
Work requirements fundamentally ignore the reality Americans face. Many already have an economic incentive to work, but face systemic barriers to stable and adequate employment (Wagner & Schubel, 2020). Lack of economic opportunities, lack of transportation, and inconsistent hours – challenges common among those living in rural areas and people of color – create obstacles to joining the workforce or meeting required monthly hours (Katch et al, 2018).
Tying healthcare coverage to a work requirement is counterintuitive. A sudden loss of coverage can be a destabilizing event that exacerbates challenges of finding and keeping a job. This is especially true for people that rely on consistent access to medication and care, such as those with behavioral and chronic health conditions (Wen et al., 2019). Conversely, evidence shows that gaining healthcare coverage actually makes it easier to work and look for work (Katch et al., 2018).
MYTH: Work requirements adequately protect vulnerable groups.
FACT: Many of the most vulnerable populations would risk losing coverage despite meeting requirements or qualifying for exemptions.
Among working-age enrollees with disabilities that did not qualify for Medicaid based on their disability, 6 in 10 would be subject to work requirements or be forced to navigate complex exemption processes (Katch et al., 2018). According to evaluations of three state rollouts, it is likely that many enrollees with severe health conditions were set to lose coverage, despite qualifying for an exemption, due to challenges with navigating the reporting system (Wagner & Schubel, 2020). For those with substance use disorders that severely limit work abilities or those with caregiving responsibilities, exemptions may not be granted at all (Coleman & Federman, 2025; Katch et al, 2018).
MYTH: Work requirements cut costs without impacting enrollment.
FACT: Work requirements will inevitably disenroll eligible people and produce massive administrative costs and inefficiencies.
There is a great deal of evidence to suggest that work requirements cause large reductions in Medicaid enrollment. In the first five months of Arkansas’ work requirement, 18,200 people were disenrolled, due primarily to struggles with reporting requirements, rather than failure to meet work requirements (Soni et al., 2020). Work requirements place an immense burden on individuals to regularly report hours (Sommers et al., 2019).
On top of introducing new, complex systems, work requirements risk mass disenrollment due to confusion or insufficient outreach about the policy. Nearly half of those subject to Arkansas’ work requirement said they weren’t sure if the policy applied to them, while one-third hadn’t heard anything about it at all (Wagner & Schubel, 2020). Similar unsuccessful outreach efforts were seen in near-implementations in New Hampshire and Michigan, in which roughly 40% and 33% of those subject to work requirements were set to lose coverage, respectively (Wagner & Schubel, 2020).
Lastly, the administrative cost of implementing and monitoring a Medicaid work requirement is disproportionate to the small minority of the population it targets. Significant staff capacity would be required to sufficiently support those navigating the system. Georgia’s Pathways to Coverage program, the state’s alternative to Medicaid expansion that hinges on a work requirement, has cost at least $40 million – over 80% of which went towards administrative costs (United States Senate Committee on Finance, 2024).
In conclusion, Medicaid work requirements create harm without benefit
Medicaid work requirements consistently create unintended consequences that harm those outside its target population and strip away coverage from those who need it most, all while producing hefty administrative burden with no positive impact on employment.
To improve workforce development and financial security, states should instead invest in areas such as job training programs, expanded access to healthcare, and transportation (Wagner & Schubel, 2020).
References
Coleman, A., & Federman, S. (2025, January 14). Work requirements for Medicaid enrollees. The Commonwealth Fund. https://www.commonwealthfund.org/publications/explainer/2025/jan/work-requirements-for-medicaid-enrollees
Katch, H., Wagner, J., & Aron-Dine, A. (2018). Taking Medicaid coverage away from people not meeting work requirements will reduce low-income families’ access to care and worsen health outcomes. Center on Budget and Policy Priorities.
Lukens, G. (2024). Research note: Most Medicaid enrollees work, refuting proposals to condition Medicaid on unnecessary work requirements. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/11-12-24health-researchnote.pdf
Sommers, B. D., Chen, L., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2020, September). Medicaid work requirements in Arkansas: Two-year impacts on coverage, employment, and affordability of care. Health Affairs, 39(9). https://doi.org/10.1377/hlthaff.2020.00538
Sommers, B. D., Goldman, A. L., Blendon, R. J., Orav, E. J., &Epstein, A. M. (2019, September 12). Medicaid work requirements– results from the first year in Arkansas. The New England Journal of Medicine, 381(11), 1073-1082. https://www.nejm.org/doi/full/10.1056/NEJMsr1901772
Soni, A., Gian, C., Simon, K., & Sommers, B. D. (2020, December 1). Levels of employment and community engagement among low-income adults: Implications for Medicaid work requirements. Journal of Health Politics, Law and Policy, 45(6), 1059-1082. https://doi.org/10.1215/03616878-8641567
United States Senate Committee on Finance. (2024, December18). Wyden, Ossoff, Warnock seek watchdog investigation into waste and mismanagement in Georgia Pathways program (news item). https://www.finance.senate.gov/chairmans-news/wyden-ossoff-warnock-seek-watchdog-investigation-into-waste-and-mismanagement-in-georgia-pathways-program
Wagner, J., & Schubel, J. (2020). States’ experiences confirm harmful effects of Medicaid work requirements. Center on Budget and Policy Priorities. https://www.cbpp.org/sites/default/files/atoms/files/12-18-18health.pdf
Wen, H., Saloner, B., & Cummings, J. R. (2019, April). Behavioral and other chronic conditions among adult Medicaid enrollees: Implications for work requirements. Health Affairs, 38(4). https://doi.org/10.1377/hlthaff.2018.05059