Take the new Congressional legislative proposal H.R. This measure would be the first step to apply onerous federal work requirements to Medicaid, putting health coverage at risk for millions of Americans. Georgia is now the only state that mandates such requirements. If the bill passes, it will implement across-the-board federal mandates for the entire country for the very first time.
The bill, as introduced, consists of both House and Senate versions of the legislation, with notable differences in compliance timelines. Unlike the House version, the Senate version does not require states to come into compliance with the new work requirements until January 2026. The Senate provides for a longer compliance phase-in, pushing it to the end of 2028.
Historically, Arkansas was the first state to see such work requirements implemented, resulting in the state’s largest-ever drop in people covered by Medicaid. The fight over these new requirements is escalating. Lawmakers and advocates are raising a number of unnecessary hardships that people will face in trying to meet the work requirement.
The bill clarifies exemptions for some delineated groups. This means adults with dependent children and those facing special circumstances, such as health conditions. Unfortunately, these exemptions still leave a lot of uncertainty whether people will continue to keep their Medicaid coverage.
“Exemptions don’t always work, and people could lose coverage anyway.” – Orris
Under current federal law, it is illegal to condition Medicaid eligibility on work or reporting burdens. In addition to reinstating the waiver, the new bill allows states to apply for a good faith waiver. This waiver provides them an additional two years to comply with the work requirements that are being proposed. This waiver would enable states to push compliance deadlines further into 2028, creating a buffer for states that may struggle to implement the new rules effectively.
Others express concern that establishing work requirements would disenroll individuals from health coverage who are least able to afford it. These fears continue to exist even with the possible accommodations. Advocates note that the vast majority of people Medicaid does not benefit from work requirements are already working as soon as they’re able to.
“Many people on Medicaid, if they’re able to, are already working.” – Robin Rudowitz
The scope of this legislation’s implications go far beyond just new compliance deadlines. Critics of Medicaid work requirements have pointed out the very serious consequences of disenrollment. Others will not be able to meet the work requirements or have barriers that make it difficult for them to have consistent work. Even with these exemptions, people still face the loss of their coverage. Bureaucratic hurdles and confusions around eligibility status usually lead to this problem.
Congress is for now considering these proposals. At the same time, states should be pushed to consider the broader impacts of introducing work requirements on health programs designed to serve low-income individuals and families. The availability of health care is just as frequently the deciding factor in being able to maintain a job. Millions of people rely on Medicaid for critical health care needs.