As many as 10 million people could lose Medicaid coverage because their work hours may be insufficient or inconsistent under incoming national work requirements, a new study suggests.
Researchers at Boston University estimate that 20% of Medicaid-eligible adults in expansion states may be at risk for noncompliance with the work requirements. The eligibility requirements are mandated across the country starting on Jan. 1 as part of the One Big Beautiful Bill Act.
The study was published Friday in JAMA Health Forum. The researchers analyzed data from 2023 to 2025 Current Population Survey, which includes information on employment of adults between the ages of 18 and 65.
The study notes that while the focus has been on the administrative hurdles in place, which can lead to disenrollments for individuals who are eligible, there has been less investigation into the work habits of individuals enrolled in the Medicaid program.
About two-thirds of the applicable Medicaid recipients were in the labor force, according to the study. Of those who were working, most (85%) were working more than 35 hours on average.
However, there are barriers for many of these individuals in reaching the 80-hours per month threshold under the work requirements, the study found. For example, many of these enrollees hold low-wage jobs in areas like retail, hospitality, food service, healthcare and agriculture, which may come with inconsistent and hard-to-predict hours.
In addition, these individuals may struggle with transportation to work or with securing childcare, the study found, and some may have undiagnosed health conditions or disabilities that make it more difficult to consistently meet the new nationwide requirements.
The study found that 19.8% of eligible recipients in expansion states were at risk of failing to meet the requirements, with 13.6% close to the 80 hour threshold and 7.6% having highly inconsistent work hours.
“These results show that the ideological narrative of Medicaid recipients just needing to pull themselves up by their bootstraps does not consider the precarious employment and other real-world barriers that often prevent them from maintaining stable work over time,” study lead and corresponding author Paul Shafer, associate professor of health law, policy & management and codirector of the Boston University Medicaid Policy Lab, said in a press release.
“These new work requirements are going to be tougher to fulfill for people with less education, part-time jobs or gig work, who have less control over their hours, and those who have substantial health concerns that may not rise to the level of a documentable disability," Shafer said.
He added that stable insurance coverage through Medicaid can help support work for these individuals, as when their health is better managed, they're more able to work effectively.
The study also found that certain populations were at higher risk than others. For example, women had a 22% higher chance of insufficient or inconsistent work hours compared to men. Married couples had an 18% lower risk than unmarried individuals, too, per the analysis.
Enrollees with a college degree were at lower risk than those with a high school diploma, the study found, while whites had a higher risk of noncompliance than Black or Hispanic individuals.
Shafer said in the release that single mothers with children in high school would likely be one of the most impacted groups.