House Republicans are reviving efforts to add work requirements to Medicaid. As part of their 2025 budget plan, lawmakers have proposed that certain adult recipients must work, volunteer, or attend school for at least 80 hours per month to keep their health coverage. The idea is not new—but this year, it’s gaining new traction in Congress.
Who would these requirements apply to?
The proposed rules would affect non-disabled adults aged 19 to 55. Exemptions would include:
- Pregnant individuals
- Full-time students
- Primary caregivers for children under age 6 or for people with disabilities
- Those deemed medically unfit for work
States would determine how to enforce the rules, but all enrollees in the affected age group would have to regularly verify their work activity or exemption status.
What would count as “work”?
The plan defines “community engagement” to include more than just traditional employment. Accepted activities may include:
- Part-time or full-time work
- Job training or GED classes
- Volunteering for a nonprofit or government agency
- Enrollment in college or vocational school
Each state could adjust what qualifies, but the federal standard would be 80 hours of activity per month.
How would verification work?
States would be required to collect and verify monthly proof of compliance. That could include employer pay stubs, school transcripts, or signed statements from volunteer supervisors. Many states would likely use online portals for reporting, but individuals without internet access may need to visit local offices or mail in documentation. Missing paperwork could result in a loss of coverage.
What’s the goal—and what are the risks?
Supporters argue that work requirements promote independence and reduce reliance on public benefits. They also say these rules mirror policies in food assistance and housing programs. However, critics point out that past efforts to enforce Medicaid work rules have led to people losing coverage—even if they were working but failed to report correctly. A 2018 Arkansas pilot led to more than 18,000 people being removed from Medicaid before courts blocked the rule.
Will this become law?
The budget plan including these requirements stalled in committee on May 16, but the debate isn’t over. Work requirements remain a central issue for many Republican lawmakers. If passed, states would need to request waivers and design their own enforcement systems. Legal challenges are also expected if the policy moves forward.
Bottom line: be prepared if you’re on Medicaid
While no national work requirement exists yet, change could be coming. If you’re an adult Medicaid recipient in the 19–55 age range, pay attention to updates from your state and prepare to show proof of work or exemption. The future of your health coverage may depend on it.
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