"Work requirements are a blunt tool that creates costly administrative
red tape and separates eligible people from health coverage they rightfully qualify for."
—Katherine Hempstead, senior policy adviser, RWJF
How Many Expansion Adults Could Lose Medicaid Under Federal Work Requirements?
Brief
Mar-01-2025
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1-min read
More than 5 million adults could lose Medicaid coverage in 2026 if Congress enacts a work requirement in states that expanded their Medicaid programs.
The Issue
Researchers analyze policy proposals that would withhold federal funding for people enrolled in Medicaid expansion ages 19 to 55 who do not report working for at least 80 hours per month.
Key Findings
- Between 4.6 and 5.2 million adults living in states that expanded Medicaid would lose Medicaid coverage next year under work requirements.
- More than nine in 10 adults with Medicaid expansion coverage already work, are looking for a job, attend school, are caring for family members, are in fair or poor health, or reported having a disability.
- If work requirements are not explicitly limited to the Medicaid expansion population, researchers say more than 30 million adults ages 19 to 55 could be subject to them, and coverage losses would be substantially higher.
Conclusion
Researchers conclude that most people who would lose coverage under a Medicaid work requirement would do so because of difficulty filling out paperwork, not because they can work and choose not to do so.
About the Author/Grantee
The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.
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