Adrian McGonigal Reported His Hours
Adrian McGonigal worked full time at a chicken processing plant in Arkansas. When the state launched Medicaid work requirements in June 2018, he reported his hours as required. Three months later, a pharmacist told him the state had cut off his Medicaid.
18,164 people lost coverage in Arkansas in 7 months. Most were still eligible. No evidence the requirement increased employment. Adrian McGonigal died of a heart attack before Thanksgiving 2024.
His COPD medication cost roughly $800 out of pocket. Without his breathing treatments, his health deteriorated. He lost his job at the plant.
His failing health made it impossible to keep part-time work. Arkansas restored his coverage in January 2019, but the damage was done. McGonigal died of a heart attack a few days before Thanksgiving 2024.
Georgia Spent More on the Portal Than on Healthcare
Georgia’s Pathways to Coverage program requires work reporting through an online portal built by Deloitte for $50 million. The portal crashed every time Kelsey Williams, a single mother, tried to apply. She called the customer service hotline and was sent through a phone tree that ended in voicemail.
Luke Seaborn, age 54, appeared in a state-produced testimonial video for Governor Kemp’s program. After two years navigating the system, he gave up. “I used to think of Pathways as a blessing. Now, I’m done with it.”
A working supermarket cashier in Atlanta lost her Medicaid and SNAP after giving birth, despite meeting the work requirements. The state said she “failed to report that I was working.”
The Numbers Behind the Names
In Arkansas, 18,164 people lost coverage in 7 months. Half reported problems paying medical debt. 56% delayed care. 64% delayed medication.
The New England Journal of Medicine found no evidence the requirement increased employment.
The OBBBA extends this to the entire country. CBO estimates 11.8 million will lose Medicaid coverage. More than 9 in 10 Medicaid expansion adults already work, attend school, are caregiving, or have a disability.
The requirement does not create jobs. It creates paperwork that people like Adrian McGonigal cannot survive.
What You Can Do
- Stop the $911 billion Medicaid cut →
- Read the Medicaid work requirements analysis and the state trigger laws brief.
- Share these stories. Names make the argument that numbers alone cannot.
Update, June 3, 2026: The Trump administration released final Medicaid work requirement regulations on June 1, giving states less than seven months to overhaul eligibility systems before the federal enforcement deadline. The rules, issued by the Centers for Medicare and Medicaid Services under the One Big Beautiful Bill Act, would require roughly 18.5 million adults across 42 states and the District of Columbia to prove they are working or enrolled in an approved activity to keep their coverage.
The regulations narrowed the medical frailty exemption, requiring states to assess the severity of a person’s condition rather than accept a diagnosis alone, and explicitly excluded homelessness as a qualifying condition. More than two dozen states had planned to allow enrollees to self-attest to qualifying conditions; the new rules will require supporting documentation starting in 2028, a shift that consultants advising states described as a “significant policy pivot,” according to KFF Health News. CMS Administrator Mehmet Oz, on a June 1 press call, described the standard as “forgiving, but not foolish.”
Nebraska, which launched its own work requirement on May 1 using a nearly 300-page list of qualifying conditions, now faces a direct conflict with the federal standards. Sarah Maresh of Nebraska Appleseed called on the state to pause coverage terminations until it can reconcile its program with the new rules. Nebraska’s Department of Health and Human Services said it is reviewing the regulation.