She Was Working
A 36-year-old supermarket cashier in Atlanta had Medicaid. She had a job. She met the requirements. Then she had a baby.
After the birth, her Medicaid and food stamps were cut off. The state said she failed to report that she was working. She was working. The system failed to record it. She spent months trying to get reinstated while accumulating medical debt and struggling to feed her family.
“After I had the baby, my Medicaid and food stamps were turned off,” she told Human Rights Watch. “It’s hectic. You’re not able to reach anybody.”
A 48-year-old woman in the same city lost her SNAP benefits after missing a documentation deadline, despite submitting her verification through the state’s online portal. She now pays for private insurance out of pocket, even though her premiums recently doubled, because dealing with the bureaucracy is worse than the cost.
“What they fail to realize,” she said, “is that a lot of people working still need assistance.”
6 in 10 Already Work
The One Big Beautiful Bill Act requires most adults on Medicaid to document 80 hours of work per month to keep their coverage. The requirement applies in all 40 states plus DC that expanded Medicaid under the ACA. The deadline is the end of 2026.
6 in 10 Medicaid recipients already work full or part-time. 3 in 10 are not working because they are caregiving, disabled, sick, or in school. Fewer than 1 in 10 are unemployed for other reasons, and most of those are over 65.
The requirement is not designed to get people to work. Most of them already do. It is designed to create a documentation barrier that removes people from the program.
Arkansas Tried This. It Failed.
In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Adults ages 30 to 49 had to report 20 hours of work per week or qualify for an exemption.
In seven months, 18,000 people lost coverage. One in four of those subject to the requirement. A federal judge halted the program in April 2019.
18,000 people lost Medicaid in 7 months. Employment did not increase. Congress is imposing the same requirement nationwide.
The research is unambiguous. Employment did not increase over 18 months of follow-up. The work requirement did not create jobs or motivate anyone to find one. What it did was remove people from healthcare.
Of those who lost coverage in Arkansas, 55.9% delayed needed care because of cost. 49.8% reported serious problems paying medical debt. 63.8% delayed taking medications.
Nearly half of the people subject to the requirement did not know it applied to them. Another third had heard nothing about it. They lost coverage not because they refused to work, but because the system never told them they had to prove it.
Arkansas spent $26 million implementing the program. Employment did not change. Georgia’s similar program spent less than one in three dollars on actual healthcare services. Nearly half went to administrative systems built to verify compliance.
10.1 Million at Risk
The Urban Institute projects that between 4.9 and 10.1 million people will lose Medicaid coverage by 2028 under the new requirements. That is on top of the 10 million more uninsured the CBO projects from the bill’s $911 billion in Medicaid cuts.
19 to 37% of people who already meet the work requirement will lose coverage anyway because of documentation barriers. They work. They qualify. The paperwork system fails them.
68 million Americans receive Medicaid. It is the largest health insurance program in the country. The bill cuts it by $911 billion over ten years while imposing requirements that Arkansas proved do not work.
Read more on the Medicaid series and the trigger laws brief.