Health status of those affected by Medicaid work requirements

Background

Passed in July 2025, Trump's tax law implemented nationwide Medicaid work requirements that many healthcare experts said would adversely impact the sickest Americans.

The law dictates that adults receiving Medicaid coverage must work or volunteer for 80 hours each month or be enrolled in an educational program. While there are some exemptions to the rule, such as for those considered "medically frail," around 5 million adults are estimated to lose their Medicaid coverage by 2034, according to the researchers.

Folks most at-risk for coverage loss also among the sickest

The researchers looked at data from the National Health and Nutrition Examination Survey to assess the health profile of individuals most likely to lose their healthcare coverage under Medicaid work requirements.

The team segmented out adults aged 20-64 receiving Medicaid without Medicare, who were either employed and not working at least 20 hours per week or who were unemployed and nonexempt from work requirements.

That segmented population tended to have considerable health needs, the team found.

For example, 41.1% of the study population had three or more chronic conditions. Among individuals aged 50-64, that figure was 66.3%. Common diagnoses of those at-risk of losing Medicaid coverage included dyslipidemia, obesity, hypertension, urinary incontinence, depression and arthritis. About a fifth of the study population had at least one of these conditions, with prevalence being higher for the 50-64 crowd.

This population also tended to have significant prescription medication needs, with 12.1% of the population having at least five prescription medications. For individuals aged 50-64, that number was 19%.

Notably, folks who the study authors deemed likely to lose their Medicaid coverage were working less than 20 hours per week (22.8%) or searching for work (42.3%). The lower work, volunteer or educational engagement could, in fact, be the result of the healthcare conditions affecting these individuals, the researchers pointed out.

"For context, prior research has shown that Medicaid beneficiaries who do not meet work requirements have poorer health status than those who do," the team explained. "Consequently, many of these beneficiaries may be eligible for work requirement exemptions, although state-specific medical frailty definitions and documentation requirements may pose barriers."

This study was limited in that it relied on self-reported health status and could not account for other types of work requirement exemptions, such as functional limitations or caretaking responsibilities.

Still, the findings spell an uncertain and potentially harmful future for many Medicaid beneficiaries, the researchers noted.

"If most at-risk Medicaid beneficiaries are disenrolled due to challenges documenting clinical conditions for work requirement exemption, which the Congressional Budget Office has projected, adverse clinical outcomes from losing coverage for chronic disease treatment and prevention are likely," they concluded.

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