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Medicaid work requirements impact those currently working

A new report shows how Medicaid work requirements affect those who work, but face limited hours due to seasonal employment or gig and service work.

Sara Heath
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Published: 12 Jun 2025

A new analysis from the Urban Institute and Robert Wood Johnson Foundation calls into question whether proposed Medicaid work requirements effectively target able-bodied individuals choosing not to work.

Instead, the requirements put at risk folks struggling with what authors called unstable employment, they contended.

“Work requirements for Medicaid or any safety net programs would be a disaster in practice,” Gina Hijjawi, senior program officer at the Robert Wood Johnson Foundation, said in a statement about the report. “The overwhelming number of Medicaid enrollees who are not working do not choose to be out of the workforce. They are disabled, care for an aging or disabled loved one, live with a serious health condition, lost a seasonal job, are enrolled in school, or can’t find steady employment."

Work requirements target those facing uphill employment battle

The report's authors contend that the Medicaid work requirements -- which are part of the House-passed budget reconciliation bill that's now being considered by the Senate -- do not effectively target those who choose not to work.

Indeed, the number of able-bodied Medicaid enrollees who choose not to work is low, with only around 2% fitting this description, the report authors said.

Rather, the provisions would most likely impact those who are working unstable hours or are trying to work and facing an uphill battle, like seasonal employment or recent job loss.

Using data from the 2017–2019 Survey of Income and Program Participation, the researchers found many of those who would be beholden to federal Medicaid work requirements do already work or go to school. Around 69% of enrollees without dependents had a job or attended school while enrolled in Medicaid.

However, many of these people face challenging employment barriers that might keep them from fulfilling Medicaid work requirements. Seasonal workers and service workers with inconsistent hours would be adversely affected by work requirement policies, risking coverage for 23%.

Work as an initial coverage requirement poses challenge

In addition to impacting those with unstable work, the report authors pointed out that work as an initial coverage requirement -- meaning enrollees would need to prove they have worked or gone to school for a state-determined amount of time prior to signing up for coverage -- would be limiting.

Around a sixth of adults currently enrolled in Medicare lost their jobs prior to enrollment. If they'd been subject to the conditions for enrollment proposed in this most current bill, they might not have gained coverage.

"Though proponents of a Medicaid work requirement claim it would only deny health insurance coverage to people who can work and choose not to, the policy could actually block a much larger number of working people from Medicaid coverage," Michael Karpman, principal research associate at the Urban Institute, said in a statement emailed to journalists.

"Workers at high risk of being denied Medicaid include those who experience job loss, have temporary jobs or unstable work schedules, or have health conditions or caregiving responsibilities that affect their ability to work consistently."

Sara Heath has reported news related to patient engagement and health equity since 2015.

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