Analysis of Medicaid Work Requirements in the One Big Beautiful Bill Act

The House Republicans have passed the "One Big Beautiful Bill Act," which includes a Medicaid work requirement effective from 2026. This mandate requires states to withhold Medicaid coverage from individuals aged 19 to 64 who cannot verify they worked or participated in qualifying activities for at least 80 hours a month. The bill targets the Medicaid expansion population, notably affecting those over 50 who rely heavily on this coverage.

The premise behind work requirements is to incentivize employment and self-sufficiency, but underlying assumptions about work capacity and job quality may limit effectiveness. Data from the Kaiser Family Foundation shows nearly 60% of Medicaid adult recipients are already employed. For those not working, health limitations, particularly chronic conditions and activity restrictions, present substantial barriers, especially in the 50-64 age group. Although the bill exempts individuals with disabilities, low-income recipients often face challenges accessing exemptions due to technology and communication access limitations. Among Medicaid recipients who can work but currently do not, many face poor job prospects and are employed in low-wage roles with minimal benefits, making it unlikely that work requirements will yield higher-paying or more secure employment.

Evidence from Arkansas, the only state to implement a partial work requirement, found no increase in employment; instead, many lost coverage and subsequently delayed medical care and prescriptions. The Congressional Budget Office previously assessed that Medicaid work requirements do not increase employment but reduce program costs by limiting coverage. The act's impacts raise concerns about Medicaid access reductions rather than facilitating employment gains, intersecting with regulatory and compliance challenges for states implementing these policies. This legislative change presents a critical point for insurance professionals to reassess Medicaid program structures, eligibility criteria, and policy implications for vulnerable populations amid evolving healthcare coverage frameworks.