Doctors, patients, and health professionals face significant compensation losses as House Republicans prepare to introduce Medicaid work requirements under what they’ve termed the “big and beautiful bill.”
They’ve raised concerns that the associated bureaucracy and administrative challenges will adversely affect access to healthcare for those in need.
The new requirements will impact individuals aged 19 to 64, although there are some exceptions. States won’t be able to turn their backs on these individuals. According to estimates from the Republican Energy and Commerce Committee, nearly five million people could lose their Medicaid benefits.
Republican lawmakers assert that even those opposed to cutting Medicaid funding seem unfazed, framing the initiative as targeting “healthy” individuals who opt not to work.
“I support the work requirements,” said Rep. Don Bacon (R-Neb.). “Healthy individuals, who can work, should be seeking employment, improving their skills, or something similar. Most Americans agree with this perspective.”
Categories exempt from the requirements include people with disabilities, pregnant women, and those incarcerated or in rehabilitation. Republicans argue these groups are truly disadvantaged.
Yet, those who qualify for exemptions must still prove their status, necessitating the correct documentation submitted in a precise manner once they’ve applied for Medicaid.
It appears likely that Republican leaders will speed up the implementation timeline for work requirements. This rapid rollout could lead to millions losing Medicaid coverage just as the 2028 presidential election season heats up.
Currently, work requirements are projected to deliver substantial savings within the health sector, estimated at around $301 billion over seven years, largely by reducing the number of individuals receiving benefits, with no mandate linking these to employment or other types of support.
“We’re not saving money by cutting costs or improving health. If the federal government saves money, it just means states are spending it, or individuals aren’t getting healthcare, underscoring that these proposals lack any magical efficiency,” remarked one critic.
Georgia is currently the only state with work requirements for Medicaid, part of its limited Medicaid expansion. Individuals earning up to the federal poverty threshold can access benefits if they adhere to the mandates.
Tanisha Corp, a 47-year-old social worker from Atlanta, explained her desperate search for health insurance after losing her nonprofit job last summer. She experienced significant challenges with the digital application process, having to submit it three times without success. Eventually, she was approved but had to contend with gaps in her coverage.
“I send emails, often without receiving a clear response,” she shared, recounting her struggles with the state’s verification process. After months without insurance, she finally got approval in March.
This lapse forced her to delay routine health checks and worry about the medical expenses for her college son after a sports injury, but the retroactive approval eventually helped cover those costs.
Critics of the work requirements worry that stories like Tanisha’s will become commonplace if the bill passes.
“The unintended consequence is that it creates hurdles for individuals attempting to qualify because they can’t navigate the paperwork,” noted Energy and Commerce ranking member Frank Pallone Jr. (D-N.J.), as discussions continued late into the night.
According to the Health Policy Research Group, KFF, there’s no widespread issue of non-working adults on Medicaid.
KFF’s research from 2023 indicates that nearly two-thirds of the 206.1 million adults aged 19-64 covered by Medicaid are employed. The remaining individuals often face challenges like caregiving duties, illness, disabilities, or attending school.
“We’re talking about low-income folks leading complex lives. Many are juggling various jobs or transitioning between them, making them vulnerable to falling through the cracks,” explained KFF’s vice president of health policy.
These work requirements also shift significant costs onto states. Georgia’s experience shows that their investments in online eligibility and registration upgrades far exceed the expenditures on medical benefits for those enrolled.
The legislation allots $100 million to assist states with registration and verification processes.
Work requirements are a core aspect of the Republican vision to reform Medicaid into a program aimed at the most needy, rather than purely a health insurance option.
During Trump’s first term, the Health and Human Services Department encouraged states to seek exemptions for implementing such requirements, viewing them as a path out of poverty.
Arkansas was the sole state to roll out work requirements, beginning in 2018, but faced setbacks when federal judges intervened in 2019, resulting in over 18,000 individuals losing coverage within the first five months, and only a fraction recovering their benefits the following year.
