U.S. States Push Medicaid Work Requirements Despite Arkansas Lessons

Multiple states, including Indiana, are seeking federal approval to implement work requirements for Medicaid recipients. These requirements are seen by Republican officials as a way to encourage employment among Medicaid beneficiaries. However, previous efforts, particularly in Arkansas, have shown significant challenges and unintended consequences.

Arkansas was the only state to fully implement such a work requirement during the Trump administration, resulting in over 18,000 people losing coverage. The policy required Medicaid recipients aged 30 to 49 to prove 80 hours of work or volunteer service each month. The reporting system proved confusing, leading many to lose benefits despite eligibility. Studies found no increase in employment rates but a rise in uninsured individuals.

New proposals from states like Ohio, Georgia, and Arkansas aim to reduce administrative burdens by using existing data and removing monthly reporting. They also plan to provide job-finding support and assign caseworkers or "success coaches" to assist beneficiaries. While some policymakers view these revisions as improvements, there remains concern about potential coverage losses and the administrative complexity of enforcing work requirements.

The Congressional Budget Office estimates a national work requirement could save $100 billion federal funds over 10 years but may result in 1.5 to 5 million people losing Medicaid coverage. Critics emphasize the diversity of state conditions and caution against a one-size-fits-all federal mandate. Alternatives to work requirements for reducing Medicaid spending include capping federal funding or reducing contributions for expansion populations, but these come with risks of significant enrollment and service reductions.

Experts suggest any new work requirement policies should be piloted carefully to gather evidence on efficacy and minimize harm.