More than 6M could lose Medicaid over work requirements

More than six million people could lose Medicaid coverage next year if Congress enacts work requirements for adults under the age of 65, according to an analysis prepared by the Urban Institute with support from the Robert Wood Johnson Foundation. Researchers say the coverage losses would occur even though the overwhelming majority of people enrolled through Medicaid expansion already work, are engaged in work-related activities, or could meet exemption criteria like being a family caregiver.

Researchers estimate that 5.5 to 6.3 million adults living in states that have expanded Medicaid could lose their coverage next year under federal work requirements that extend to adults up to age 64. At least 10,000 adults would lose coverage in nearly all of the 41 states that expanded Medicaid, and more than 100,000 people would lose coverage in 17 of those states.

The analysis is based on proposed federal legislation from 2023, and researchers say a similar proposal currently being debated in Congress would lead to even higher coverage losses in each state because it would not only affect people already enrolled but also apply to new enrollees.

“Federal lawmakers seem ready to advance a policy that has been proven to be ineffective, costly, and damaging to millions of working families,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “Medicaid work requirements don’t work. They don’t promote employment, and they take coverage away from people who don’t have other options. The ripple effects of enacting federal work requirements will be felt across local healthcare systems and economies for years.”

“The recently proposed Medicaid work requirement would not only cause millions of adults to lose their Medicaid coverage but would also create new barriers to enrollment by requiring applicants to prove they’re already working or qualify for an exemption,” said Michael Karpman, principal research associate at the Urban Institute. “This approach has been tested in Georgia, where only a small fraction of eligible adults have successfully enrolled. The proposed federal work requirement will inevitably result in the loss of health insurance for millions of workers, people who lose their jobs, people with disabilities or serious health conditions, and others who fall through the cracks of the new reporting bureaucracy.”

Number of Adults Ages 19 to 64 Who Could Lose Medicaid Expansion Coverage Next Year Under Federal Work Requirements

Read the full analysis, Expanding Federal Work Requirements for Medicaid Expansion Coverage to Age 64 Would Increase Coverage Losses

Nearly nine in 10 adults (89%) age 19-64 who would be subject to these requirements already work, are looking for work, attend school, or could meet exemption criteria, such as being a family caregiver or having a disability. Researchers say this number could be higher because some adults, particularly older adults, may have a health condition that prevents them from working that is not observable in the data.