Work Requirements Threaten Health and Increase Costs

Decades of research show that work requirements do not move people off assistance and into self-sufficiency; instead they increase costs to states and taxpayers, harm health, keep eligible people from obtaining needed assistance, terminate health insurance coverage and other benefits, and drive people and families—already struggling to make ends meet—deeper into poverty. 

Policymakers are considering adding work requirements to Medicaid and increasing them for the Supplemental Nutrition Assistance Program (SNAP). Yet we know that most people who get their health insurance through Medicaid and most participants in SNAP are already working.

The evidence is clear: Work requirements harm everyone, including seniors whose families rely on Medicaid to pay for their long-term nursing care, children, people with disabilities, and working families with low incomes. Beyond harming individuals, work requirements are also costly and inefficient.

Here is what the research shows about work requirements:

Most Medicaid and SNAP Participants Are Already Working

Among Medicaid participants who are not enrolled in disability or Medicare programs, 64% work full or part-time. The most common reasons for not working include unpaid caregiving responsibilities (12%), illness or disability (10%), and school attendance (7%). Data from the 2023 American Community Survey also confirm that more than 80% of families receiving SNAP had at least one person working in the past 12 months before receiving benefits, including families with and without people who have disabilities.

Work Requirements Terminate Coverage and Strip People of Benefits that Promote Health and Wellbeing

The Center on Budget and Policy Priorities estimates that if work requirements were implemented to Medicaid nationally, as many as 36 million people—about 44% of all Medicaid enrollees—could be at risk of having their health insurance terminated. Work requirements in SNAP have also been shown to significantly reduce program participation among eligible adults by as much as 53%. 

Work Requirements Disproportionately Harm People With Disabilities

Around 15 million people with disabilities get their health insurance through Medicaid, but 66% are unprotected from work requirements because they qualify through non-disability pathways such as Medicaid expansion. To claim an exemption, people are often forced to navigate confusing processes and systems. In states that expanded Medicaid, employment among adults with disabilities increased by nearly 6% after expansion allowed them to obtain healthcare coverage for the first time. Taking away this coverage risks reversing those gains, forcing more people with disabilities out of the workforce.

Red Tape Discourages Participation and Increases Administrative Costs and Burdens

Monitoring and enforcing work requirements burdens enrollees and program administrators alike. Arkansas witnessed this when the state temporarily introduced Medicaid work requirements. This terminated health insurance for 18,000 people and cost the state and federal government $26.1 million in administrative expenses—without increasing employment. Georgia's Medicaid program with work requirements cost more than $40 million in its first year, with nearly 80% of funds going to administrative and consulting fees rather than healthcare. As of February 2025, enrollment is still far short of the program’s goals.

Policy Alternatives

If the objective is truly to increase labor force participation and reduce reliance on government programs, lawmakers should invest in solutions that support employment, such as job training, affordable childcare, and higher wages.