A bipartisan group in the House introduced H.R. 1059, the Jobs and Opportunities for Medicaid Act, on February 6, 2025. If passed, it would amend Title XIX of the Social Security Act to require most able-bodied adults on Medicaid to work or volunteer at least 20 hours per week, starting January 1, 2026 .
This provision aims to encourage workforce participation among healthy adults without dependents. However, it excludes those under 18, over 65, pregnant individuals, primary caregivers of young or disabled children, medically unfit persons, and enrollees in unemployment or substance-use programs .
What the bill requires
Under the proposed law, an “able-bodied adult” must meet one of two criteria each month:
- Work at least 20 hours per week (based on a monthly average).
- Volunteer at least 20 hours per week (based on a monthly average).
Those failing to satisfy either will lose Medicaid coverage for that month .
Who qualifies as “able-bodied”
The bill defines able-bodied adults to exclude:
- Anyone under 18 or over 65.
- Individuals medically certified as unfit for work.
- Pregnant people.
- Primary parents or caretakers of a dependent child under 6.
- Caregivers of a child with serious medical needs.
- Those receiving unemployment benefits and complying with existing work rules.
- Participants in drug or alcohol treatment programs .
These exemptions aim to protect vulnerable groups while targeting situations where added activity could build job skills and community engagement.
State implementation and flexibility
States would enforce the requirement through their Medicaid agencies. They must track work and volunteer hours, handle exemptions, and process appeals. The bill allows states to use existing workforce programs and community service opportunities to help enrollees meet the threshold.
If a month is missed, coverage suspends for that month, but enrollees can requalify by fulfilling the requirement in a subsequent month.
Potential impact on enrollment and budgets
Supporters argue the work mandate will:
- Boost employment by connecting enrollees with jobs or volunteer agencies.
- Reduce state Medicaid spending by removing coverage from non-compliant adults.
- Encourage self-sufficiency and community involvement.
Critics warn it may:
- Increase the uninsured rate, as some may struggle to meet or document the hours.
- Overburden state agencies unprepared for new tracking and appeals processes.
- Disproportionately affect rural or transit-poor areas, where job and volunteer options are scarce.
Early estimates suggest states could save millions annually, but administrative costs and potential coverage losses could offset some gains.
Legislative outlook and next steps
H.R. 1059 was referred to the House Committee on Energy and Commerce. Key upcoming actions:
- Committee hearings on implementation logistics and projected costs.
- State testimony from Medicaid directors on operational challenges.
- Debate and amendment period before a full House vote, expected in mid-2025.
The Senate would need to pass companion legislation, and the president would have to sign it into law. If enacted by late 2025, work requirements would begin January 1, 2026.
What beneficiaries should know
Medicaid enrollees likely to be affected should:
- Track hours: Keep records of employment or approved volunteer activities.
- Seek exemptions: Apply early if they qualify under health, caregiver, or other categories.
- Connect with resources: Use state workforce offices or community organizations to find opportunities.
States will publish guidance on approved volunteer programs and reporting procedures closer to the effective date.
Key takeaway
H.R. 1059, the Jobs and Opportunities for Medicaid Act, represents a significant shift in Medicaid policy by tying coverage to a minimum level of work or volunteering for most healthy adults. Stakeholders will watch state implementation plans and the bill’s effect on coverage, employment rates, and program costs as it moves through Congress.
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