FACT SHEET: Medicaid Work Requirements Would Jeopardize Health
Coverage and Access to Care for 21 Million Americans
Prior research shows that work reporting requirements reduce enrollment in health
coverage, limit access to care, and do not increase employment.
Work requirements would add substantial bureaucratic red tape to Medicaid, putting coverage – and health –
at risk for millions of Americans. Only one state has ever fully implemented these policies, and nearly 1 in 4
adults subject to the policy lost their health coverage – including working people and people with serious
health conditions—with no evidence of increased employment.
1
In fact, research shows that more than 95%
of enrollees subject to the policy already met the requirements or should have qualified for an exemption –
but many lost coverage because they couldn’t navigate the red tape.
2
According to a recent HHS report analyzing 2021 Census data, the vast majority of working-age Medicaid
enrollees are already employed, have a disability, and/or are parents.
3
Previous research indicates that among
enrollees who aren’t already working, nearly all have disabilities, serious health conditions, childcare or
caretaking responsibilities, or are in school.
4,5
Nonetheless, the administrative burden for enrollees to report adherence to or exemption from Medicaid
work requirements could put 21 million Medicaid beneficiaries in this age group at risk of coverage loss.
Administrative churning is a significant issue with Medicaid eligibility redeterminations, and new reporting
requirements will compound this problem.
6
Loss of Medicaid coverage can force patients to change providers,
skip medications, or face financial difficulties, and coverage loss has been tied to worse quality of care and
worse health.
7
The tables below illustrate the estimated number of people in each state and respective counties whose
coverage would be at risk under the general work requirements approach proposed recently by House
leadership.
8
The tables only include states that have expanded Medicaid under the Affordable Care Act, since
the proposed policy would likely affect much smaller numbers of people in non-expansion states.
*
The tables
present enrollment statistics from the Centers for Medicare & Medicare Services (CMS) as of December 2022
(the most recent available data) on the number of adults ages 19 to 55 in Medicaid who are not enrolled via
disability, parent/caretaker, or pregnancy-related eligibility pathways.
It is important to note that, while individuals enrolled through a disability pathway would be excluded from
the new requirements, many people with disabilities enroll in Medicaid via the expansion group pathway, and
their coverage could be at risk. In addition, our estimates do include parents who enroll through the expansion
pathway; while some states may be able to automatically exempt these individuals based on parental status,
this will depend on data availability and how states implement the policy.
Instead of making it harder for people to get health insurance, the Biden-Harris Administration is committed to
working with states to test new innovative ways to deliver health care, lower costs for Americans, and expand
coverage rather than pursue policies that take coverage away from millions of Americans.
*
Nearly all Medicaid enrollees in this age group in non-expansion states are enrolled via eligibility pathways as parents /
caretakers, pregnant, or having a disability; depending on implementation of the policy, these groups would likely be
automatically exempted from the work requirements reporting requirement.
TABLE: Number of Medicaid Enrollees Potentially Subject to Work Reporting Requirements, By State
(Medicaid Expansion States Only)
State
Total State
Population
Total Medicaid and
CHIP Population
Potentially Subject to Work Reporting
Requirements:
Medicaid Enrollees, Ages 19-55, not Enrolled
via Disability, Pregnancy, or Parent
Eligibility Pathways*
Total
228,365,217
69,996,284
Alaska
735,951
263,656
72,087
Arizona
7,079,203
2,291,196
Arkansas
3,006,309
1,041,085
414,346
California
39,455,353
14,078,007
Colorado
5,723,176
1,699,630
641,351
Connecticut
3,605,330
1,008,718
Delaware
981,892
300,480
82,892
District of Columbia
683,154
292,727
Hawaii
1,453,498
459,261
150,871
Idaho
1,811,617
452,903
Illinois
12,821,813
3,788,584
1,427,125
Indiana
6,751,340
2,011,078
Iowa
3,179,090
850,906
227,106
Kentucky
4,494,141
1,618,816
Louisiana
4,657,305
1,896,206
673,054
Maine
1,357,046
367,372
Maryland
6,148,545
1,685,151
437,308
Massachusetts
6,991,852
1,977,039
Michigan
10,062,512
3,048,240
930,133
Minnesota
5,670,472
1,380,680
Missouri
6,141,534
1,453,302
291,746
Montana
1,077,978
324,866
Nebraska
1,951,480
390,562
76,528
Nevada
3,059,238
870,550
New Hampshire
1,372,175
249,906
85,880
New Jersey
9,234,024
2,202,958
New Mexico
2,109,366
884,416
282,336
New York
20,114,745
7,408,878
North Dakota
773,344
130,665
33,775
Ohio
11,769,923
3,365,244
Oklahoma
3,948,136
1,294,297
326,344
Oregon
4,207,177
1,380,287
Pennsylvania
12,970,650
3,674,072
1,025,768
Rhode Island
1,091,949
362,512
Utah
3,231,370
482,074
128,076
Vermont
641,637
192,634
Virginia
8,582,479
2,003,672
655,359
Sources:
Total state population is from 2021 ACS 5-Year Estimates, Accessed at:
https://data.census.gov/table?t=Population+Total&g=010XX00US$0500000&tid=ACSDT5Y2021.B01003
The total Medicaid and CHIP population counts are from the Medicaid and CHIP Eligibility and Enrollment Performance Indicator Data
as of April 21, 2023. The counts of adult Medicaid enrollees are from the T-MSIS Analytic File (TAF) Beneficiary Summary File v.7 for
December 2022. Information regarding the quality and usability of data for this analysis available at www.medicaid.gov/dq-atlas under
Total Medicaid and CHIP Enrollment and Eligibility Group Code topics.
Notes:
* The results include Medicaid enrollees receiving Medicaid and CHIP benefits at the state level for the population of adults aged 19-55
excluding those who are eligible for Medicaid due to disability, parent/caretaker, or pregnancy. The sample in this analysis was for
adults 19-55 with full-scope / comprehensive benefits enrolled for at least one day during December 2022. Totals exclude enrollees
with missing or invalid state codes due to state-submitted data quality issues.
Washington
7,617,364
2,168,482
West Virginia
1,801,049
645,172
219,788
REFERENCES
1
Issue Brief No. HP-2021-03. “Medicaid Demonstrations and Impacts on Health Coverage: A Review of the Evidence.”
https://aspe.hhs.gov/pdf-report/medicaid-demonstrations-andimpacts. Washington, DC: Office of the Assistant Secretary
for Planning and Evaluation, U.S. Department of Health and Human Services. March 2021. Accessed at:
https://aspe.hhs.gov/reports/medicaid-demonstrations-impacts-health-coverage-review-evidence
2
Sommers BD, Goldman AL, Blendon RJ, Orav EJ, Epstein AM. Medicaid Work Requirements - Results from the First Year
in Arkansas. N Engl J Med. 2019;381(11):1073-1082. doi:10.1056/NEJMsr1901772
3
Lee A, Ruhter J, Peters C, De Lew N, Sommers BD. Medicaid Enrollees Who are Employed: Implications for
Unwinding the Medicaid Continuous Enrollment Provision (Issue Brief No. HP-2023-11). Office of the Assistant Secretary
for Planning and Evaluation, U.S. Department of Health and Human Services. April 2023.
https://www.aspe.hhs.gov/reports/employed-medicaid-enrollees
4
Goldman AL, Woolhandler S, Himmelstein DU, Bor DH, McCormick D. Analysis of Work Requirement Exemptions and
Medicaid Spending. JAMA Intern Med. 2018;178(11):1549–1552. doi:10.1001/jamainternmed.2018.4194
5
Garfield R, Rudowitz R, Guth M, Orgera K, Hinton E. Work Among Medicaid Adults: Implications of Economic Downturn
and Work Requirements. Kaiser Family Foundation. February 11, 2021. Accessed at:
https://www.kff.org/reportsection/work-among-medicaid-adults-implications-of-economic-downturn-and-work-
requirements-issue-brief/
6
Issue Brief No. HP-2022-20. “Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects
and Policy Approaches” Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of
Health and Human Services. August 19, 2022. Accessed at:
https://www.aspe.hhs.gov/reports/unwinding-medicaid-
continuous-enrollment-provision
7
Sugar S, Peters C, DeLew N, Sommers BD. Medicaid Churning and Continuity of Care: Evidence and Policy Considerations
Before and After the COVID-19 Pandemic (Issue Brief No. HP-2021-10). Washington, DC: Office of the Assistant Secretary
for Planning and Evaluation, U.S. Department of Health and Human Services. April 12, 2021. Accessed at:
https://aspe.hhs.gov/reports/medicaid-churning-continuity-care
8
Limit, Save, Grow Act of 2023. Speakers Office. Accessed at: https://www.speaker.gov/wp-
content/uploads/2023/04/LSGA_xml.pdf