Regulatory

Medicaid work requirements could drive 5M off of coverage in expansion states, study finds

By Paige Minemyer Mar 21, 2025 4:20pm
Medicaid Medicaid Work Requirements Urban Institute Kathy Hempstead

If the feds were to institute work requirements in Medicaid for states that have expanded their programs, it could push more than 5 million people off of their coverage, according to a new analysis.

The report, from researchers at the left-leaning think tank the Urban Institute, estimates that coverage losses could range from 4.6 million to 5.2 million if work requirements were put in place. Not limiting these requirements explicitly to the expansion population could significantly increase the number of people losing coverage, as it would impact more than 30 million adults aged 19 to 55.

The data are based on experiences with work requirements in Arkansas and New Hampshire. The researchers estimate that 13.3 million people in the expansion population would be subject to work requirements in 2026 should they be implemented.

Of that group, 7 million would be automatically exempted or deemed compliant, while an projected 1.1 million to 1.8 million would need to report their work activities or obtain an exemption.

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The remaining group would likely become uninsured, according to the report.

Most people in the expansion population are working already or would meet other exemptions, the researchers note. Nine in 10 individuals covered under Medicaid expansion meet coverage criteria, including being employed, actively looking for work, attending school, serving as a caregiver for a family member, are in fair or poor health or have a disability.

“Work requirements are a blunt tool that creates costly administrative red tape and separates eligible people from health coverage they rightfully qualify for,” said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation, which supported the research, in a press release. 
 
“Nearly all adults who gained coverage through Medicaid expansion already meet work requirements," she said. "People would not lose healthcare coverage because they are ineligible. They would lose coverage because of the bureaucratic burden the program would put on people across the country.”
 
The findings for the expansion population are based on work requirements as outlined in the Limit, Save, Grow Act. However, the researchers note that other proposals could impact coverage losses.
 
For example, one approach would also institute work requirements for people aged 56 to 64, which would grow the group needing to come into compliance significantly. Policymakers could also limit exemptions for people serving as caregivers or other groups.
 
The Trump administration is looking to make substantial cuts to federal spending, and it's likely that to achieve the broad changes the White House is aiming for, entitlement programs like Medicaid will be on the docket. 

Medicaid Medicaid Work Requirements Urban Institute Kathy Hempstead Robert Wood Johnson Foundation Payers Regulatory