Medicaid helps tens of millions of people stay healthy, care for their families, and navigate life’s hardest moments. It’s a critical lifeline for people with disabilities. But some lawmakers in Congress are pushing a policy that would do little more than make it harder for people to access that care: Medicaid work requirements.
On paper, work requirements might sound reasonable. Proponents claim they encourage people to find work and contribute to society. But in practice, we’ve already seen how this plays out, and the evidence is clear: Medicaid work requirements don’t increase employment. They do nothing to address “waste, fraud, and abuse.” And they fail to do anything to lower health care costs. Simply put, they just take health care away from people who need it.
We’ve Tried This Before. It Didn’t Work.
In 2018, Arkansas became the first state to implement a Medicaid work-reporting requirement. Officials promised it would boost employment among low-income adults. It did not. Instead, the program stripped health care coverage from ove 18,000 Arkansans.
People lost health care not because they weren’t working, but because they got caught in a maze of red tape. The online reporting system was confusing. Reporting requirements were burdensome. People with disabilities, caregivers, and those juggling health issues or unstable schedules fell through the cracks. And after 18 months, there was no increase in employment.
Georgia Followed Suit — With the Same Results
In 2024, Georgia launched a similar program requiring monthly work reports from adults earning up to 100 percent of the federal poverty line (about $15,000 a year). Despite more than 110,000 people wanting to enroll, fewer than 5,500 made it through the process.
Why the gap? The same story: confusing applications, unclear eligibility rules, and bureaucratic barriers. Over 40 percent of people who wanted to apply could not wade through the paperwork. One in five who did were denied.
The costs of these ineffective policies? Enormous. Georgia spent more than $13,000 per enrollee — five times the original estimate — with most of that money going not to health care, but to building and running a bureaucracy.
This Isn’t About Encouraging Work. It’s About Cutting People Off.
Work requirements don’t acknowledge the reality of low-wage work in America. Many people who qualify for Medicaid are already working — and paying taxes. But often they are working in jobs with unpredictable hours, no sick leave, and no health benefits. Others are caring for family, recovering from illness, or dealing with disabilities that make full-time employment difficult or impossible.
Instead of helping people work, these policies punish them for circumstances beyond their control. And rather than investing in job training or support, they impose harsh rules specifically designed to make getting health care harder.
The Hidden Cost: Discrimination and Inefficiency
These policies not only waste taxpayer dollars, they’re patently unjust and bad policy.
Work requirements disproportionately harm people with disabilities. Many disabled people fall into coverage gaps because they don’t meet strict federal definitions of disability yet still face serious barriers to employment. Work requirements ignore that reality, and the result is lost coverage, worse health outcomes, and deepening inequality.
Congress Shouldn’t Pick on Vulnerable People Who Need Health Care
Work requirements make access to health care more burdensome and overwhelming. They target vulnerable individuals whose life circumstances are already dire and who may lack the resources and wherewithal to overcome obstacles created by new, confusing bureaucratic hoops.
Work requirements neither encourage employment nor create a healthy, stable workforce. They are nothing more than a not-so-subtle backdoor to cut Medicaid and deny individuals the health care they need.
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