Medicaid work requirements: What they are and why the Trump administration supports them

The latest: "For many, welfare is no longer a lifeline to self-sufficiency but a lifelong trap of dependency," Kennedy wrote in the new essay. Center for Medicare and Medicaid Services administrator Mehmet Oz, Agriculture Secretary Brooke Rollins and Housing and Urban Development Secretary Scott Turner were also listed as co-authors.

• While lawmakers seek savings to implement tax cuts, the Trump officials argued work requirements are "not just about money."
• They added: "Work also provides purpose and dignity."

Context: House Republicans recently unveiled $880 billion in Medicaid cuts, which include work requirements for the health insurance safety net, which serves more than 71 million Americans.

• Under GOP bill, many Medicaid recipients under 65 years old, without dependents, would be required to confirm that they work, perform community service or participate in an educational or work program for at least 80 hours a month.

Friction point: Republicans say they're rooting out waste and aiming to avoid subsidizing adults who "choose" not to work. Democrats warn millions of people would lose coverage under the proposed changes.

• The nonpartisan Congressional Budget Office estimated that the provision and other changes would reduce the number of people with health insurance by more than 8 million by 2034.

Reality check: 64% of adults with Medicaid worked full or part time in 2023, according to analysis from the Center on Budget and Policy Priorities.

• Another 32% were taking care of home or family, were ill or disabled, were attending school, or were retired.

Why do Republicans want work requirements?

Rep. Brett Guthrie (R-Ky.), the chairman of the House Energy and Commerce Committee, argued that "Washington can't afford to undermine the program [Medicaid] further by subsidizing capable adults who choose not to work" in a Sunday op-ed making his case for the bill.

• He added, "Every other capable adult works to afford healthcare," describing the work requirements as "sensible."

Context: Work requirements have proven to be a more politically palatable provision among other potential big changes, Axios' Maya Goldman reports.

• According to a February KFF poll, more than 60% of adults support work requirements as a condition of Medicaid eligibility.
• Broadly, however, more than three-quarters of U.S. adults surveyed in April said they opposed major funding cuts to Medicaid.

Friction point: Not all Republicans are singing in harmony over their approach to Medicaid.

• Sen. Josh Hawley (R-Mo.) candidly contended in a Monday New York Times op-ed that slashes to the safety net program would be "morally wrong and politically suicidal."

What do critics say?

The other side: Critics of Medicaid work requirements argue they erect unnecessary red tape that leaves eligible people uninsured.

• The Center for American Progress characterized work reporting requirements as "at best redundant," citing KFF's findings that 92% of Medicaid enrollees who did not receive benefits from the Social Security disability programs and were under 65 years old were working in 2023.
• CAP argues Medicaid itself supports employment by providing an "insurance lifeline" to workers who are not offered employer-sponsored health insurance or cannot afford coverage.
• "In practice, work requirements only measure a person's ability to navigate administrative red tape, not whether they are actually working or looking for a job," the center contended.

Case in point: KFF pointed to Congressional Budget Office analyses of proposed Medicaid work requirements that found while such policies lower federal spending as people lose eligibility, they have little effect on employment.

Critics also say these provisions mean that people lose care as soon as they lose their jobs.

• "Work requirements are actually job loss penalties," Nicole Jorwic, chief program officer at Caring Across Generations, an advocacy group, said on a call with reporters Monday.

How have Medicaid work requirements affected enrollment in the past?

In Arkansas, which implemented work and reporting requirements with consequences for noncompliance between June 2018 and March 2019, over 18,000 reportedly people lost coverage.

• People who lost coverage primarily did so because of failure to report work status or document their eligibility for an exemption, per KFF.
• Providers reported that vulnerable employees, like those who have disabilities or who are homeless, were the most likely to struggle to comply with the requirements, according to KFF.

Threat level: The complexity of such policies, according to the Center on Budget and Policy Priorities, increases the risk that those meeting the requirements and those who should be exempt will lose benefits.

Zoom out: In Georgia, work requirements were attached to a Medicaid expansion effort — but the program fell far short of expectations and need, per a report from the Georgia Budget and Policy Institute.

Earlier this year, Kentucky's GOP-controlled legislature overruled Democratic Gov. Andy Beshear's veto on work requirements for Kentuckians to be eligible for Medicaid coverage.

• A prior requirement proposal from former Kentucky Gov. Matt Bevin could have led to nearly 100,000 Kentuckians losing Medicaid coverage, Kentucky Public Radio reported — but it was blocked by Judge James Boasberg in 2018.

What has Trump said about Medicaid work requirements?

The first Trump administration encouraged and approved several state work requirement waivers.

• But there were legal barriers, and the Biden administration upon taking office withdrew work requirement waivers in the states that had approvals.

Zoom in: Now, work requirements could have new life.

• Rep. Jason Smith, the chair of the House Ways and Means Committee, told Fox News earlier this month that Trump "shows an openness" to work requirements for Medicaid but that he did not want to "cut benefits" for individuals.
• Office of Management and Budget Director Russ Vought signaled to Senate lawmakers during his confirmation hearing in January that he supported work requirements.
• In 2020, under the first Trump administration, Vought said a universal work requirement for Medicaid would "ensure that we are helping to lift able-bodied adults off of a cycle of dependency and onto a ladder of economic opportunity."

Yes, but: The Center on Budget and Policy Priorities' director of Medicaid eligibility, Jennifer Wagner, stated her view simply to Axios' Emily Peck: "Work requirements don't work."

Go deeper: Why work requirements for Medicaid "don't work"

Editor's note: This story was corrected to reflect that the essay was published on Wednesday (not Tuesday). It was also updated with new developments.