Medicaid Work Requirements: Why They Make It Harder to Keep Working

What Are the New Medicaid Work Requirements?

A new federal rule will require most adults on Medicaid to work at least 80 hours a month starting in 2027. This policy, known as Medicaid work requirements, aims to push people into jobs. But evidence from Arkansas shows it often does the opposite. Instead of helping people work, it makes it harder to keep working.

The Real Story: What Happened in Arkansas

In 2018, a man in Arkansas went to pick up his medicine. He found out his Medicaid was gone. He hadn't lost his job or made more money. He just couldn't complete the new paperwork. Without medicine, his health got worse. He missed work. Then he lost his job.

This is not a rare story. Harvard researchers studied Arkansas, the only state to fully enforce work requirements. Here is what they found:

• 18,000 people lost coverage in seven months.
• Employment did not go up. It stayed flat for 18 months.
• 95% of people already met the work rules or had an exemption.

Most people who lost coverage were working, in school, or disabled. They just couldn't prove it every month. Half reported serious medical debt. 56% delayed care. 64% skipped medications.

Why Paperwork Is the Real Problem

A work requirement is really a paperwork requirement. To keep Medicaid, you must report hours every month. This is hard for people without stable internet, a car, or an HR department. For someone with a disability, monthly digital reporting can be impossible.

The irony? A policy sold as pro-work can pull the ladder out from under people already working. If you lose Medicaid, you lose the medicine or care that helps you work. Then you lose your job.

How This Hurts the Economy

Today, many jobs are gig work, part-time, or multiple jobs. These jobs don't give a clean pay stub on the first of the month. Tying health coverage to monthly paperwork creates a tax on low-wage workers. Employers see higher turnover and lost productivity. Workers delay care until it becomes an emergency.

What States Can Do to Fix It

The rule is coming. States must comply by January 1, 2027. But they can choose how to do it. Smart states will:

• Use data they already have (like payroll records) to verify work automatically.
• Make exemptions automatic for people with disabilities.
• Design systems for the hardest-to-reach people first.
• Write notices in plain language and offer help by phone, in person, and online.

If states just check boxes, they will repeat Arkansas on a national scale. That means millions losing coverage for no good reason.

What You Can Do Right Now

There is a short comment period open until the end of July. Disability groups, employers, and state agencies can push for better rules. The goal? Broader exemptions and simpler processes. This window is small but powerful.

Medicaid work requirements don't have to hurt people. But without careful design, they will make it harder to keep working for the people who need help the most.