As Congress and state lawmakers reignite debates over Medicaid work requirements, new data shows that while work mandates are politically popular among some conservatives, they’ve had little success helping recipients find or keep jobs.
Why States Are Pushing Medicaid Work Rules Again
Several Republican-led states — including Ohio, Iowa, Montana, and Arkansas — are reviving or proposing work requirements for nondisabled adult Medicaid enrollees. The argument: tying health coverage to employment will reduce dependency and promote economic self-sufficiency.
This comes amid federal efforts to reduce spending, with some lawmakers proposing cuts to Medicaid’s $880 billion budget to offset tax extensions and border funding.
Sen. Josh Hawley of Missouri, a Republican, has emerged as a surprising defender of Medicaid benefits — insisting he supports work requirements but will oppose any cuts that reduce coverage for Missourians.
“Will it result in reductions to benefits to Missourians? That’s my test,” Hawley said.
The Reality: Most Medicaid Enrollees Already Work
Despite the push for mandates, experts stress that most Medicaid recipients already work or are unable to for legitimate reasons:
- Nearly 2 out of 3 enrollees are employed.
- Others are caregivers, students, or medically unable to work.
- Many employed recipients work in low-wage jobs without benefits.
“There are a lot of people freeloading in Medicaid — that’s just not supported by the evidence,” said Ben Sommers, health economist at Harvard.
Past Mandates Failed to Boost Employment
Case Study: Arkansas (2018–2019)
- 18,000+ people lost coverage before courts blocked the work mandate.
- Many reported confusion over how to log work hours.
- Employment rates did not improve, according to federal studies.
Georgia (2023–Present)
- The only state with an active work requirement.
- Early data shows minimal enrollment in associated job programs.
Where Job Support Did Help — and Why It’s Rare
Programs like CareSource’s JobConnect in Ohio have shown promise. Enrollees are paired with life coaches who offer training, resume help, and interview prep.
- Since 2023, ~800 people have found jobs via the program.
- The health plan itself hired 29 Medicaid enrollees in full-time roles.
Another standout: University of Pittsburgh Medical Center has hired over 10,000 Medicaid enrollees since 2021 through targeted training.
But such programs are the exception. Most state Medicaid plans don’t offer employment help, and private insurers often lack incentive to assist — if enrollees earn too much, they lose Medicaid, and the insurer loses a customer.
Political Shift: Medicaid Gains Ground in Red States
Voter-driven initiatives have expanded Medicaid in several conservative states. In Missouri, voters enshrined expansion in the state constitution, covering over 348,000 low-income adults.
“When you expand Medicaid anywhere, you help protect it everywhere,” said Kelly Hall of the Fairness Project.
That expansion makes it harder for state leaders to cut Medicaid outright. Instead, lawmakers now explore indirect cost-saving measures, like work requirements, optional benefit reductions, or provider rate freezes.
What’s at Stake for Enrollees
Optional services like dental, home-based care, and medical equipment could face future cuts — especially in states like Missouri where Medicaid now accounts for 26% of state spending.
And while political pressure mounts, the Congressional Budget Office warns that work requirements wouldn’t improve employment but could leave 600,000 people uninsured, shifting costs to states and potentially undermining access to care for vulnerable populations.
Key Takeaways:
- Most Medicaid enrollees already work or can’t work due to valid reasons.
- Past work requirements failed to improve employment and led to coverage losses.
- Supportive job programs work — but they’re rare and underfunded.
- Voter support for Medicaid has made direct cuts politically risky.
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