Medicaid Work Requirements: What’s Really Going On?

You ever get that sinking feelinglike you're doing everything right, but the rug could still get pulled out from under you at any second?

Maybe you're working full time but can't afford health insurance. Maybe you're raising kids, caring for an aging parent, or managing a chronic illness. And somehow, Medicaid is the one thing keeping you afloat. It's not charity. It's survival.

Now, imagine being told: "Prove you're busy enoughor we're cutting your coverage."

That's what Medicaid work requirements are all about. And right now, they're back on the tablein Georgia, in Congress, and in the lives of millions of real people like you and me.

So, let's talk. Not like politicians. Not like bureaucrats. But like humans. Because this isn't about red tape or budget line items. It's about whether someone like James in Montanaa guy working hard to stay sober and employedhas to hide his raise to keep his meds.

Let's unpack this, piece by piece.

What Are They?

First things firstwhat even are Medicaid work requirements?

In short, they're rules that say: if you want or want to keep Medicaid, you've got to log at least 80 hours a month doing something the government counts as "work." That could be a job, of course. But it can also be volunteering, job training, or even caregivingif it's approved.

Now, these rules don't apply to everyone. They mostly target adults under 65 who don't have disabilities and were added to Medicaid through the Affordable Care Act expansion. But here's the kicker: most of these people are already working, caregiving, or dealing with health barriers.

So why impose a rule that doesn't fix the problem it claims to solve?

Well, at the federal level, a 2025 budget bill is pushing for nationwide work requirements by the end of 2026. The idea? Save moneyaround $344 billion over ten years, according to the Congressional Budget Office.

And at the state level? Only one program is currently active: Georgia's Pathways to Coverage.

Who's Behind It?

The push for Medicaid work requirements isn't newit flared up big time during the Trump administration. Back then, 13 states got approval to try it. But most were shut down when President Biden took office, calling them harmful and ineffective.

All except Georgia.

Georgia fought in court, and their waiver survived. Today, Pathways to Coverage is the only state program actively enforcing work and reporting rules.

But here's the wild part: they rolled it out expecting 25,000 people to enroll in the first year.

By January 2025? Just 6,500.

Meanwhile, they've already spent over $40 million80% on administration, consultants, and tech systems. Now, they're dropping $10.7 million on advertising just to get people to sign up.

Wait, you have to advertise a health program meant for low-income folks and still can't get traction?

That tells you something.

Who Relies on Medicaid?

Let's get real for a sec. Who are we even talking about?

When people say, "If you can work, you should work," it sounds fair. But it assumes most Medicaid users aren't working. And that's just not true.

According to KFF (Kaiser Family Foundation), 92% of non-disabled, non-elderly adults on Medicaid are already either employed, in school, caregiving, or dealing with health issues that limit their ability to work.

Break it down:

• 64% are workingfull-time or part-time
• 12% are primary caregivers
• 10% are managing chronic illness or disability
• Only 8% are unemployed for other reasons

So why make a rule that affects the 8% and risks hurting the 92%?

And the jobs? They're not high-paying gigs. Think home health aides, restaurant workers, farmhands, retail clerks. Many employers don't offer health benefitsand when they do, the premiums can eat up half a paycheck.

That's why Medicaid matters. It's not a handout. It's the thing that keeps someone from choosing between insulin and rent.

Who's at Risk?

Let's talk about the people most likely to lose coverage under these rules.

Older adultsespecially ages 50 to 64are a big group. Nearly 1 in 5 in this age bracket rely on Medicaid. Many have disabilities but don't qualify for SSI. Over 85% of those who aren't working cite health reasons.

Then there are caregiverslike Joanna, a 31-year-old in California caring for her disabled mom and aging grandparents. Her work is full-time, unpaid, and invisible to the system.

And what about people battling mental illness or addiction? Medicaid covers therapy, medication, recovery programs. Stability comes from carenot the other way around.

If you think work requirements help these folks "get back on their feet," you've probably never walked a day in their shoes.

Georgia's Case Study

Let's zoom in on Georgiabecause what's happening there might be a preview of what's coming nationally.

Their Pathways to Coverage program requires 80 hours a month of work, training, or volunteering. You have to report itonlineevery month. No exceptions at first for caretakers or people with health barriers.

And the result?

Massive confusion. Low enrollment. And people who qualify not signing up, because the rules feel like a trap.

Why? Because if you lose your job tomorrow, your Medicaid vanishesno grace period. One missed report, one typo, one tech error? Dropped.

And many don't have reliable internet, computers, or the digital know-how to file reports online. There's no phone line. No paper option. Just a portaland a deadline.

It's not just cruel. It's inefficient.

But here's a twist: Georgia's waiver is up for renewal in 2025, and they're proposing changeslike annual reporting instead of monthly, and exemptions for parents of young kids.

Good? Sure. But after $40 million spent and thousands already scared off, is it too little, too late?

Lessons from Arkansas

Georgia isn't the first to try this.

Arkansas was the firstand onlystate to fully implement Medicaid work requirements, back in 2018.

And what happened?

Over 18,000 people lost coverage. Not because they weren't working. Most were working. But they failed to file reportsbecause the system only accepted online submissions.

No paper. No phone. No email.

And the kicker? There was no real increase in employment. But there was a measurable rise in medical debt, skipped care, and people going without prescriptions.

The GAO reviewed several states' attempts and found admin costs ranged from $10 million to $270 millionmoney that could've gone to actual healthcare.

So let's be clear: paperworknot lazinessis what costs people their coverage.

Federal Bill Breakdown

Now, Congress is trying to bring this model nationwide.

The 2025 House budget bill would require 80 hours a month of work or approved activity for all ACA expansion Medicaid enrollees. It starts at the end of 2026states can jump in earlier.

Verification happens at sign-up and every six months. They'll even do a "look-back" to check if you met requirements in past months.

There are exemptionsfor pregnancy, serious illness, addiction treatment, and caregiving. But the Senate version limits the caretaker exemption to kids under 14. After that? Tough luck if you're raising a teenager with special needs.

And if you fall short?

You get 30 days to prove you met the requirement. After that? Dropped from Medicaid. Not only thatyou can't switch to Marketplace plans with subsidies. You're just on your own.

What's the Impact?

The CBO has projected what this could mean on a national scale:

Outcome	Estimate (10-year)
Federal savings	$344 billion
Adults losing Medicaid	5.2 million
Uninsured increase	4.8 million
Employment impact	No significant increase

Let that sink in: nearly 5 million more Americans without health coverage and no real uptick in jobs.

The CBO's conclusion? These rules don't boost employment. They just push people off Medicaid.

Pros and Cons

Look, we should acknowledge why some support this idea.

Some argue it promotes personal responsibility. That if taxpayers are funding healthcare, recipients should "give back" by working. Others say it reduces long-term dependency on government programs.

And sureon paper, that sounds noble.

But in practice?

The risks far outweigh the benefits.

Risk	Reality
People lose coverage not for not workingbut for paperwork	Proven in Arkansas and Georgia
No proof it increases jobs	CBO and academic studies agree
Hurts the most vulnerable	Older adults, caregivers, disabled
Creates a "benefit cliff"	One raise = lost healthcare
Massive administrative burden	Georgia spent $40M in 18 months

As Dr. Ben Sommers, a health economist at Harvard, put it: "We see vilification of mostly very hardworking people who are benefiting from a program that helps them stay alive."

That hits hard. Because Medicaid isn't about handouts. It's about stability. It's about being able to show upto work, to parenthood, to recoverybecause you're not one illness away from bankruptcy.

Better Solutions?

If work requirements don't help people work what does?

Turns out, support works better than mandates.

People don't need punishment. They need childcare, transportation, job training, mental health services.

But Medicaid doesn't fund thoseand that's the irony. We're pushing people to work but not giving them the tools to get there.

Programs like SNAP and TANF already offer these supports. Why not let Medicaid learn from them?

Better yet:

• Adopt 12-month continuous eligibilityso coverage doesn't lapse every time someone gets a raise or loses a shift. Montana used to have it. James, the man keeping his sobriety with Medicaid-funded care, is scared of what happens if it doesn't come back.
• Use automated enrollmentpull data from tax records or SNAP to keep people covered without endless forms.
• Use healthcare as a foundationbecause study after study shows access to care helps people stay employed, not the other way around.

Healthcare doesn't replace work. It enables it.

The Bottom Line

Let's bring it home.

Medicaid work requirements sound simple: work or lose coverage. But real people don't live in a soundbite.

They live in shifts, in doctor's visits, in paycheck-to-paycheck survival.

They're James in Montana, who knows one more promotion could cost him his meds. Joanna in California, giving everything to her family, only to be seen as "not contributing." Ashton in Georgia, feeling like the Pathways ads are a personal insult.

This isn't about laziness. It's about a system that confuses compliance with compassion.

We can save $344 billion or we can save lives.

We can build walls of paperwork or bridges to care.

If you're someone who's worried about your coverage, know this: you're not alone. And you're not invisible.

Your workpaid or unpaidmatters. Your health matters. Your story matters.

So if you've been affected by these rules, I hope you'll speak up. Talk to your lawmakers. Share your experience. Demand policies that helpnot hurt.

Because the truth is, we all do better when we support each other. Not when we set traps and call them opportunities.

What do you think? Have you or someone you know faced these kinds of rules? I'd love to hear your thoughtsno judgment, just connection.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.