What you need to know
Medicaid is the federal-state program that provides health care to over 75 million Americans. Republicans have proposed adding work requirements to Medicaid eligibility as part of the “One Beautiful Bill" budget reconciliation measure. What are the policy implications of this measure?
- House Republicans have proposed adding work requirements to the Medicaid program.
- In this brief, Everything Policy researchers highlight the likely impact of the new requirements, including an increase in government efficiency and a reduction in the number of eligible people receiving benefits.
What is Medicaid?
Medicaid is a joint federal-state health insurance program for children, low-income individuals and families, pregnant women, the blind, and other disabled persons. Though largely federally funded, it is run by individual states, so specific eligibility requirements vary. Most Medicaid costs are covered by the federal government.
What are the proposed work requirements?
The proposed House budget bill requires Medicaid recipients to meet certain community engagement requirements, which have been widely reported as “work requirements.” However, the bill defines five ways in which an individual can meet these requirements:
- work 80 hours per month
- perform 80 hours per month of community service
- attend a work-training program for 80 hours per month
- be enrolled as at least a half-time student
- any combination of 1-4 that totals 80 hours in a month
The Act also includes several exemptions to these requirements, some of which all states must adhere to (mandatory) and some of which states may allow (optional). Mandatory exemptions include: persons under the age of 19, pregnant women, blind persons, mentally or physically disabled persons, caretakers of disabled persons, persons with a substance-use disorder or mental disorder, and those released from incarceration in the past 3 months, among others.
Optional exemptions include hospitalized individuals, those living in a county under a disaster declaration, those living in a county with greater than 8% unemployment (or 1.5 times the national unemployment rate), or any other hardship identified by the Secretary of Health.
What is the logic for work requirements?
The central rationale for adding work requirements to Medicaid is the belief that people who can work to support themselves should be required to do so, rather than receiving federal benefits for free. Providing free health care to otherwise able-bodied individuals reduces their incentive to find employment that either provides health care as a benefit or pays them enough to afford insurance on the open market. Finally, insofar as work requirements encourage some recipients to return to the workforce, the policy could reduce Medicaid enrollments and the program’s cost.
Creating these incentives has a potential secondary cost: all Medicaid recipients would have to complete paperwork every six months to certify that they meet work requirements or qualify for an exemption. The concern is that some otherwise-qualified recipients will lose benefits because of incomplete paperwork or processing errors.
How many Medicaid recipients would fall under the work requirements?
While there are over 75 million Medicaid recipients, about 28 million are able-bodied adults between 18 and 64 years old. (The rest are children, seniors, or disabled.) Of those 28 million recipients, data from the Department of Health and Human Services shows that almost two-thirds already satisfy the work requirements, and an additional 30 percent qualify for one of the mandatory exemptions. Thus, if the proposed requirements were implemented, it is projected that two million individuals would have to start working or otherwise meet the requirements to remain qualified for Medicaid.
In terms of budgetary impacts, the nonpartisan Congressional Budget Office analyzed a similar 2023 work requirements proposal. It concluded that work requirements would reduce federal Medicaid spending by $109 billion over ten years and reduce Medicaid enrollments by 1.5 million people. However, about a third (600,000) of the reduction would be people eligible for Medicaid who failed to certify that they were working or were exempt from the requirement.
The Takeaway
Based on the current wording of the House budget proposal, Medicaid work requirements will impact about two million people out of over seventy-five million recipients.
Implementing the proposed work requirements could potentially save the federal government about $100 billion over ten years.
Judgments about the desirability of implementing work requirements for Medicaid reflect an individual’s evaluation of two competing goals: creating work incentives and reducing federal spending versus providing benefits to a broader group of individuals who otherwise would qualify for Medicaid.
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Further reading
Herd, P., & Moynihan, D. P. (2019). Administrative burden: Policymaking by other means. Russell Sage Foundation, accessed 5/22/25.
Baumrucker, E., Binder, C.; Braun, S, .; Colello, K., .; Mitchell, A, Napili, A., &; Saraswathula, V. (2024). Medicaid: An Overview. Congressional Research Service, https://www.congress.gov/crs-product/R43357, accessed 5/22/25.
Sources
Bureau of Labor Statistics. (2025). Local Area Unemployment Stats. Available at https://www.bls.gov/lau/lauov.htm, accessed 5/21/25.
Lyon, S.M., I.S. Douglas, and C.R. Cooke. (2014). Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep. Annals of the American Thoracic Society. Available at https://tinyurl.com/5feujd9d, accessed 5/21/25.
Schaefer, N.O. (2025). Commonsense Medicaid Reforms for 2025. Heritage Foundation. Available at https://tinyurl.com/4bbxpp8a, accessed 5/21/25.
Tolbert, J., S. Cervantes, R. Rudowitz, and A. Burns. (2025). Understanding the Intersection of Medicaid and Work: An Update. Kaiser Family Foundation. Available at https://tinyurl.com/mpk39zs, accessed 5/21/25.
Schaefer, N.O. (2025). Commonsense Medicaid Reforms. Heritage Foundation. Available at https://tinyurl.com/4bbxpp8a.
U.S. Congress. (2025). A Bill to Provide Reconciliation pursuant to title II of the Concurrent Resolution on the Budget for Fiscal Year 2025, H. Con. Res. 14. Available at https://tinyurl.com/2s3u4htb, accessed 5/21/25.
Congressional Budget Office. (2023). CBO’s Estimate of the Budgetary Effects of H.R. 2811, the Limit, Save, Grow Act of 2023. Available at: https://tinyurl.com/mry92xsh, accessed 5/22/25.
Contributors
John Arnold (Intern) is a sophomore at Binghamton University majoring in Political Science and Economics
Robert Holahan (Content Lead) is Associate Professor of Political Science at Binghamton University (SUNY). He holds a PhD in Political Science from Indiana University where his advisor was Nobel Laureate Elinor Ostrom. His research focuses on natural resource policy, particularly in domestic oil and gas production, but also extends into international environmental policy. He was PI on a National Science Foundation grant that utilized a 3000-person mail-based survey, several internet-based surveys, and a series of laboratory economics experiments to better understand Americans’ perspectives on energy production issues like oil drilling and wind farm development.
William Bianco (Research Director) is Professor of Political Science at Indiana University and Founding Director of the Indiana Political Analytics Workshop. He received his PhD from the University of Rochester. His teaching focuses on first-year students and the Introduction to American Government class, emphasizing quantitative literacy. He is the co-author of American Politics Today, an introductory textbook published by W. W. Norton now in its 8th edition, and authored a second textbook, American Politics: Strategy and Choice. His research program is on American politics, including Trust: Representatives and Constituents and numerous articles. He was also the PI or Co-PI for seven National Science Foundation grants and a current grant from the Russell Sage Foundation on the sources of inequalities in federal COVID assistance programs. His op-eds have been published in the Washington Post, Indianapolis Star, Newsday, and other venues.
