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work requirements
'So It Begins': Trump's Medicaid Work Requirements—as Designed—Wreak Havoc and Pain
"Pregnant woman disenrolled by mistake. Long waits to get through to the call center for help. No clarity on the rules. Medicaid work reporting requirements don’t work."
Aug 03, 2026
A growing chorus of Democratic lawmakers, policy experts, and advocacy organizations is calling on the Trump administration to immediately rescind a rule imposing more strict work reporting requirements on Medicaid recipients, a demand that came as Nebraska began kicking people off the healthcare program for not complying with the new mandates.
Under the expanded requirements, which were established by a 2025 Republican budget package that President Donald Trump signed into law, certain Medicaid recipients must document at least 80 hours per month of work or another qualifying activity to continue receiving assistance. In a statement late last week, Families USA executive director Anthony Wright warned that "these new paperwork requirements will push patients off coverage—not because they aren’t working or not eligible, but because of bureaucratic burdens."
Wright noted that under new rules stemming from the 2025 GOP budget law, even people with terminal cancer and other serious illnesses aren't necessarily exempt from the work reporting requirements, which apply to people between the ages of 19 and 64 who don't have a disability and aren't pregnant, in states that expanded Medicaid under the Affordable Care Act.
"The requirement that a patient doesn’t just need to have cancer or another condition but must produce the equivalent of a doctor’s note with a finding that the conditions leave them unable to work," said Wright, "is nowhere in the underlying statute, and unworkable."
A pair of Democratic lawmakers, Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone Jr. (D-NJ), similarly warned in a letter late last week that the Trump administration's implementation of the new work requirements "transforms Medicaid from a healthcare program into a bureaucratic maze that will fail eligible Americans, by design."
"It will strip coverage from people not because they are not already working or refuse to work, but because they cannot navigate a complex web of forms, passwords, and deadlines," the lawmakers wrote. "Implementing ineffective, exclusionary work reporting requirements will create costly administrative barriers and deny Americans access to health care, resulting in poorer health, higher mortality, and reduced financial security."
Wyden and Pallone urged the Trump administration to withdraw what the lawmakers described as a "disenrollment scheme" as Nebraska became the first in the US to disenroll Medicaid recipients for failing to comply with the reporting mandates.
The advocacy group Nebraska Appleseed has warned that the work requirements could put 40,000 Nebraskans at risk of losing Medicaid coverage. The requirements took effect in Nebraska on May 1—eight months ahead of schedule—and the state began disenrolling people for purported noncompliance on August 1.
In a blog post published last week, Nebraska Appleseed observed that the three months between the start of the work requirements and the first round of disenrollments was marked by "mass confusion," with Medicaid recipients experiencing "long call center waits, inoperable language lines, understaffed and undertrained caseworkers, policy questions gone long-unanswered, and the lack of public state data."
Joan Alker, executive director of the Center for Children and Families at Georgetown University, pointed with alarm to local reporting about the early impacts of the work reporting mandates in Nebraska.
"So it begins," Alker wrote in a social media post on Monday. "Pregnant woman disenrolled by mistake. Long waits to get through to the call center for help. No clarity on the rules. Medicaid work reporting requirements don’t work."
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Trump Admin Argues Even Terminally Ill Patients Shouldn't Be Exempt From Medicaid Work Requirements
Under a new policy the administration is defending in court, low-income people with cancer, HIV, Parkinson's, and other life-threatening illnesses must prove they're too sick to work or risk losing their health insurance.
Jul 30, 2026
A federal judge on Thursday denied a request by more than two dozen Democratic states to halt a Trump administration policy announced last month that would require Medicaid recipients with terminal diseases to prove they are too sick to work in order to be exempt from new work requirements that go into effect this coming January.
While introducing over $1 trillion in tax cuts for the wealthiest 1% of Americans, last year's massive GOP tax and budget bill also imposed new 80-hour-per-month work requirements that states must implement for Medicaid expansion recipients, who receive government-subsidized insurance coverage at or below 138% of the poverty line.
The law specified that those who are “medically frail or otherwise have special medical needs” are excluded from the work requirement, and specifically listed people with a “serious or complex medical condition.” But it remained unclear what exact conditions met these criteria.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) introduced a new rule stating that even if a person receives a terminal diagnosis for a disease like cancer, HIV/AIDS, or Parkinson's, that is still not enough for them to be exempt from the work requirements.
Beginning on January 1, 2028, it says they must also demonstrate to states that their condition “significantly impairs” their ability to meet the work requirement.
Democratic attorneys general in 25 states and the District of Columbia filed a preliminary injunction over the rule late last month, arguing that CMS had rewritten the law to introduce a vague and needlessly restrictive new hurdle that vulnerable people will face in obtaining desperately needed care.
“This is one of those cases where it’s really hard to overstate how dire the consequences could be,” North Carolina’s Democratic attorney general, Jeff Jackson, told Politico. “You’re going to have 50 states doing 50 different things, and we’re all going to have to create a whole new bureaucracy... You are talking about a lot more paperwork, more evaluations, more doctor visits, and a lot more work for doctors themselves.”
The Democratic AGs argued that implementation of the work requirements should be paused because they lacked the staff or capacity to meet the timeline set by CMS, which requires states to communicate to enrollees how they'll be affected by the changes by the end of August.
US District Judge Richard Stearns on Thursday denied their initial request to immediately halt the implementation of the requirements while the lawsuit proceeds, but also did not rule on the lawsuit's merits, which are scheduled to be decided before the requirements go into effect on January 1.
Several medical associations, including the American Medical Association, the American College of Physicians, and the American Academy of Pediatrics, have come out against the rule, arguing that it would have dire consequences for people who suffer from severe illness.
"One of the most significant factors in whether someone survives a cancer diagnosis is whether they have health insurance coverage," Lisa Lacasse, president of the American Cancer Society Cancer Action Network, explained in June.
"The new restrictions link the definition of medical frailty to a person’s ability to work," she continued. "This would mean cancer patients and survivors who are suffering from debilitating side effects of the disease or treatment would have to officially prove they can’t work, in a process that is likely to be difficult and take a long time."
The nonpartisan Congressional Budget Office has projected that over the coming decade, changes to healthcare policy introduced by Republicans would increase the number of uninsured Americans by about 11.8 million.
Around 5.7 million of them are projected to be Medicaid recipients who either do not meet the 80-hour work requirement or are otherwise eligible but tripped up by one of the newly imposed paperwork hurdles.
Taya Graham and Stephen Janis argued earlier this week in a piece for The Real News Network that eligible people losing coverage is not an unfortunate side effect of the law, but a goal of the Republicans who passed it, who sought a way to thin the ranks of those who qualify for Medicaid without having to take the politically unpopular step of actually clawing back benefits.
They wrote that what has happened to recipients of the Supplemental Nutrition Assistance Program (SNAP) illustrates how burdensome these new requirements may become.
As The New York Times reported earlier this month, in Arizona, 440,000 people have already been dropped from SNAP after it enacted a formidable regime of paperwork for low-income recipients to prove eligibility, including requiring some people with panhandling income to obtain documentation from donors who drop them a buck on the street.
"If this is what people receiving SNAP benefits have been subjected to," Graham and Janis wrote, "imagine what’s going to happen to people who will need to navigate the new [Medicaid] requirements while struggling with a debilitating or terminal illness."
Medical issues are a leading cause of bankruptcy in the US. According to one study, over 4 in 10 cancer patients over 50 had depleted all their assets within two years of diagnosis.
Melanie D’Arrigo, a campaigner for single-payer healthcare in New York, said that President Donald Trump "cut cancer research, cut healthcare,” and with new Medicaid restrictions, “wants to make sure Americans continue to work as they go broke battling cancer.”
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Pediatricians Warn Trump Attack on Medicaid 'Will Harm Children's Long-Term Health'
"Efforts to undercut or undermine Medicaid for the children who rely on it are a bet against the future of the country," said the president of the American Academy of Pediatrics.
Jun 04, 2026
The American Academy of Pediatrics warned Wednesday that the Trump administration's new rule governing Medicaid work requirements will damage the health of children across the US, as additional bureaucratic barriers make it more difficult for families to access and maintain coverage.
AAP, the largest professional association of pediatricians in the country, said it "strongly opposes" the rule unveiled by the Centers for Medicare and Medicaid Services (CMS) earlier this week, calling it "an intentional policy choice that will harm children’s long-term health and well-being." The group said the rule should be rescinded.
“When parents have healthcare coverage, their children are more likely to be covered and stay covered over time, allowing uninterrupted access to the care they need to grow up healthy," said Andrew Racine, AAP's president. "Work requirements have not been shown to help adults gain employment. Instead, the added red tape makes it more difficult for eligible people to stay enrolled in Medicaid and makes the program less efficient overall. These administrative barriers will disproportionately hurt people with disabilities, and parents of children with special healthcare needs will lose coverage."
"The new burdensome requirements that many parents will face under this rule will ultimately undermine families’ health and financial stability," Racine added. "The policies to narrowly define who qualifies for exemptions will add to the state costs to administer the program, create headaches for families trying to navigate the bureaucracy, and harm the very people that Medicaid is meant to serve. Medicaid is a program designed around the needs of children. Efforts to undercut or undermine Medicaid for the children who rely on it are a bet against the future of the country."
Analysts and advocacy groups have said the Trump administration's rule, which implements work requirements included in a Republican budget law enacted last summer, will likely push millions of people off Medicaid—including many who are eligible but fail to comply with complex new reporting procedures.
The Center on Budget and Policy Priorities (CBPP) noted in Wednesday analysis that state agencies "will have to significantly re-work policy and systems" in light of the new rule, likely resulting in "errors and delays that could affect health coverage and care for the entire Medicaid population—including groups to whom the work requirement doesn’t apply, such as children, seniors, and people with disabilities."
Nearly half of all children in the US are enrolled in Medicaid or the Children's Health Insurance Program (CHIP). A recent analysis by the Center for Children and Families at Georgetown University found that two million fewer children were enrolled in Medicaid in April compared to the start of President Donald Trump's second White House term—and the number of uninsured kids is expected to grow as the GOP budget law's unprecedented Medicaid cuts take hold.
In addition to its impacts on children, critics say the new CMS rule will harm people with serious illnesses such as cancer and HIV/AIDS. The rule does not necessarily exempt such people from the Medicaid work mandates, which require certain program enrollees to document at least 80 hours per week of employment or related activities. The requirement is set to take effect nationwide in January 2027.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement earlier this week that the Trump administration's new rule appears to run afoul of the law.
"People who have special medical needs, including those with a serious or complex medical condition, are statutorily exempt from the community engagement requirement," said Schmid. "People living with HIV have a lifelong serious and complex medical condition and have special medical needs—they cannot stay healthy without continuous access to lifesaving HIV treatment. Any gap will put them at risk of serious health consequences."
"We are disappointed that the Trump administration ignored the law and, while they agree that HIV/AIDS and viral hepatitis are serious or complex medical conditions, they are proposing that states will have to determine for every individual if their health is impaired and that they can’t comply with the work requirement," Schmid continued. "This added requirement was not in the law and puts the health of people living with HIV and viral hepatitis at risk."
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Trump's New Medicaid Rule 'Designed to Ensure People Lose Healthcare,' Critics Warn
"Today’s announcement marks a grim step in America’s march towards a healthcare system that further restricts access to healthcare and creates barriers rather than delivering affordable healthcare to families."
Jun 02, 2026
The Trump administration on Monday unveiled a rule that is expected to push millions of low-income people off Medicaid by imposing complex bureaucratic barriers in the form of work reporting requirements, which have proven disastrous at the state level.
The rule, released by the Centers for Medicare and Medicaid Services (CMS), marks a key step toward enacting the Republican budget reconciliation package that President Donald Trump signed into law last summer. That measure included around $900 billion in cuts to Medicaid, with new work requirements projected to account for nearly $330 billion of that total.
The new rule will dictate how states must implement the budget law's Medicaid work mandates and who is exempt from the requirements. States are already spending tens of millions of dollars hiring new staff and upgrading technology in preparation for the mandates taking effect next year.
Broadly, the Trump-GOP law requires adults without disabilities between the ages of 19 and 64 to demonstrate at least 80 hours of work, community service, or other "qualifying activities" per month to keep their Medicaid coverage.
Exemptions to the work reporting requirements include people who are pregnant, caregivers to children under the age of 14, or "medically frail." The CMS rule defines the latter category as those with "physical or behavioral health conditions that significantly impair their ability to consistently work or participate in other community engagement activities."
Advocates warned that the rule will force many sick people off coverage. The rule states that people with HIV/AIDS, end-stage renal disease, and cancer would not necessarily be exempt from the work reporting requirements.
According to The New York Times, "states had expected that people with certain serious diagnoses would qualify for the exception, and they had been developing ways to match applications with existing medical records to identify most such people automatically."
"Nebraska’s Medicaid program, which began enforcing a work requirement last month, developed a list of exempted conditions that is nearly 300 pages long," the Times reported. "The state will now need to adjust."
"When these requirements go into effect at the beginning of next year, it’s going to be a complete train wreck for America."
Anthony Wright, executive director of Families USA, said Monday that "far from protecting the vulnerable, this guidance significantly raises the barrier for demonstrating medical frailty, meaning many patients in the middle of treatment will have the new hassle of proving their condition, over and over, with any mistake or gap being penalized by the loss of their healthcare and coverage."
"Through this rule," said Wright, "CMS is requiring duplicative documentation and prohibiting states from taking full advantage of consumer-friendly tools like self-attestation."
During the first year of the work reporting requirements, which are set to take effect nationwide in January 2027, people will be allowed to attest in Medicaid applications that they meet one of the exemptions, according to administration officials.
"Beginning in 2028, states will be expected to verify the exemptions," NBC News reported. "The temporary flexibility, the officials said, is intended to give states time to build systems that can verify exemptions using claims data and other records."
The advocacy group Protect Our Care warned that the new rule "creates a labyrinth of paperwork, reporting mandates, and rigid eligibility rules designed to ensure people lose healthcare, even when they should qualify to keep it."
“Instead of lowering costs or making care more accessible, Republicans are weaponizing government bureaucracy against the American people," said Brad Woodhouse, the president of Protect Our Care. "They are betting that if they make the process confusing and exhausting enough, millions of people will fall through the cracks and lose the care they depend on to survive. Hospitals will suffer, providers will be pushed further to the brink, and families across the country will pay the price while Republicans once again put wealthy donors and corporate greed ahead of the health and well-being of everyday Americans.”
The nonpartisan Congressional Budget Office has projected that, over the next decade, the Trump-GOP work reporting requirements will push nearly 3 million people off Medicaid.
Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, said in a statement that the CMS rule "is the dark heart of the Republican plan to kick millions of working Americans and their children off their health insurance by placing a mountain of paperwork in front of them."
"These barriers are designed to prevent Americans from getting affordable healthcare, while providing a profit bonanza for the corporate consultants who get paid millions to build bureaucratic booby traps," Wyden added. "The Republican plan for healthcare is to kick people when they are down, making sick people sicker and hard times even harder. When these requirements go into effect at the beginning of next year, it’s going to be a complete train wreck for America, and not just for the Americans caught in the bureaucratic maze Republicans have created: Every community will be left with worse healthcare."
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Rights Groups Warn of Disaster as Trump-GOP Work Requirements Risk Mass Medicaid Loss
“These work requirements address a problem that doesn’t exist," said one researcher. "They just strip healthcare from millions of low-income people by making it harder for them to prove they qualify.”
May 26, 2026
A pair of leading humanitarian groups warned Tuesday that millions of people will soon be "at risk of an avoidable loss of healthcare coverage" as states move to implement new Medicaid work requirements, which were at the center of the reconciliation package enacted by congressional Republicans and President Donald Trump last year.
Oxfam America and Human Rights Watch (HRW) warned in a joint letter to top federal health officials that the work requirements—which mostly target adults in states that expanded Medicaid under the Affordable Care Act—will result in a massive surge in the uninsured population if concrete steps aren't taken to mitigate coverage losses.
The groups point to a Congressional Budget Office analysis projecting the Trump-GOP budget law "will cause roughly 10 million people to lose health insurance coverage by 2034," increasing "the number of uninsured people in the US by nearly 50%, exposing millions of people to high drug and hospital costs, and forcing many to forgo or ration healthcare."
Under the 2025 law, people subject to the work requirements must document 80 hours per month of work or another qualifying activity.
"Work requirements are sold as sensible, pragmatic reforms, but the lived reality couldn’t be more different."
Analysts have warned that the new work reporting mandates—which account for around $326 billion of the Trump-GOP law's total cuts to Medicaid—will create massive administrative hurdles and burdens for Medicaid recipients and for states. Given that most Medicaid recipients already work, experts say coverage loss from the new mandates will largely be attributable to enrollees' failure to comply with byzantine reporting procedures.
“Work requirements are sold as sensible, pragmatic reforms, but the lived reality couldn’t be more different,” said Jackson Gandour, senior policy advisor for economic justice at Oxfam America. “In practice, evidence shows they can create unfair and effectively insurmountable barriers for people who need coverage and are making every effort to meet the requirements.”
The federal work requirements are set to formally take effect in most states by January 2027—though some states are rushing forward with the mandates ahead of schedule, heightening fears of chaos and large-scale coverage loss. By June 1, federal agencies must issue guidance to states on how to implement the new Medicaid work requirements.
Oxfam and HRW urged the Trump administration to do all it can to mitigate coverage loss, including by "reducing documentation requirements, broadly interpreting exemptions, and recognizing a wide range of qualifying activities that reflect real labor conditions, including gig work, unpaid caregiving, and seasonal employment."
A 36-year-old woman in Atlanta, Georgia—which has state-level work requirements that predate the Trump-GOP mandates—told the humanitarian groups that she lost Medicaid and nutrition assistance after her child was born late last year, despite working sufficient hours to comply with Georgia's requirements.
“After I had the baby, my Medicaid and food stamps were turned off,” she said. “[They] said that I failed to report that I was working."
The woman said she's spent months trying to restore her coverage, encountering chaos and administrative barriers.
“It’s hectic,” she said. “You’re not able to reach anybody.”
The Urban Institute has estimated that even if strong mitigation measures are put in place, around 3 million people could lose Medicaid coverage due to the new federal work requirements.
“These work requirements address a problem that doesn’t exist since most Medicaid recipients are already working,” said Matt McConnell, economic justice and rights researcher at Human Rights Watch. “They won’t fix the budget. They just strip healthcare from millions of low-income people by making it harder for them to prove they qualify.”
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'Disgusting': Republicans Applaud as Trump Brags About Taking Food Aid From Millions
"His Big Ugly Bill ripped food away from hungry moms, kids, and seniors to fund tax cuts for the wealthiest Americans," said one House Democrat.
Feb 25, 2026
US President Donald Trump received a standing ovation from Republican lawmakers and administration officials Tuesday night when he bragged during his State of the Union address about taking nutrition assistance from millions, which he euphemistically characterized as lifting people off food stamps.
"In one year, we have lifted 2.4 million Americans—a record—off of food stamps," Trump said during his nearly two-hour speech.
The Republican reconciliation package that Trump signed into law last summer included $187 billion in cuts to the Supplemental Nutrition Assistance Program (SNAP) over a 10-year period, the largest cuts to the program in US history.
Trump: "In one year, we have lifted 2.4 million Americans -- a record -- off of food stamps" (In other words, Republicans cut food stamps) pic.twitter.com/19EoNEUmPF
— Aaron Rupar (@atrupar) February 25, 2026
The Republican law includes reductions in federal nutrition funding for states—which administer SNAP—as well as expanded work requirements, which the nonpartisan Congressional Budget Office estimated would strip nutrition benefits from "roughly 2.4 million people in an average month" over the next decade.
As the Center on Budget and Policy Priorities noted in a recent analysis, changes enacted by the Trump-GOP law mean that "for the first time in the 50-year history of the modern SNAP program, the federal government will no longer ensure that the lowest-income people, including children, older adults, veterans, and people with disabilities, in every state have access to the food assistance they need because states that refuse to pay the cost share could see the program end."
Shortly after Trump signed the Republican megabill into law, his administration canceled an annual US Department of Agriculture survey aimed at measuring food insecurity, undercutting efforts to track the impact of the unprecedented SNAP cuts. The USDA's final reports estimated that nearly 48 million people in the US faced food insecurity in 2024—including nearly one in five households with children.
"Trump says he 'lifted' millions off food stamps," Rep. Brittany Pettersen (D-Colo.) wrote in response to the president's State of the Union remarks. "But what he really means is his Big Ugly Bill ripped food away from hungry moms, kids, and seniors to fund tax cuts for the wealthiest Americans. The lies are blatant and disgusting."
Rep. Sarah McBride (D-Del.) denounced her Republican colleagues for their celebratory response to Trump's boast.
"They're applauding ripping food out of people’s mouths to fund their tax cuts for billionaires," McBride wrote on social media.
USDA data released ahead of Trump's speech shows that around 696,000 fewer people received SNAP benefits in November 2025 compared to the previous month.
Katie Bergh, a senior policy analyst on the food assistance team at the Center on Budget and Policy Priorities, noted that "people haven’t been dropping off SNAP because they no longer need help."
"Economic conditions haven’t improved and groceries haven’t gotten more affordable," Bergh added. "They're losing basic food assistance because of policy choices. Allowing this trend to continue is also a policy choice."
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The Shutdown Is Over, But America's Hunger Crisis Isn't
As the government reopens, millions will still lose access to food assistance starting almost immediately due to policy changes in the GOP's "Big Beautiful Bill."
Nov 17, 2025
The roughly 42 million Americans who rely on food stamps did not receive their November 1 Supplemental Nutrition Assistance Program benefits as the government shutdown dragged on. The missed payments came just as the holiday season began, leaving many families struggling to put food on the table. Lines at food banks backed up traffic across the country.
The Trump administration defied federal court orders to restore full funding to the program before the Supreme Court’s conservative majority temporarily green-lit the freeze. The White House even tried to claw back funding from states that had already distributed it to hungry families.
Lawmakers have now negotiated an end to the shutdown. But the threat to the nation’s primary nutrition assistance program, SNAP, is far from over. As the government reopens, millions will still lose access to food assistance starting almost immediately.
The GOP’s “Big Beautiful Bill,” passed earlier this year, guts core safety net programs to fund tax cuts for billionaires, mass deportation efforts, and bloated military spending. The GOP law includes the largest SNAP cuts in history, slashing our most important and effective anti-hunger program by roughly 20%.
We have the tools to fight hunger, and we must use them.
People in every state are at risk of losing their food benefits, according to the Center on Budget and Policy Priorities. One of the main ways the bill cuts SNAP is by expanding harsh and ineffective work requirements. These new rules will strip food assistance from millions of people, including children, seniors, veterans, and individuals with disabilities. According to the Congressional Budget Office, the change will cause 2.4 million people to lose benefits in an average month.
Those rules are now in effect, just as families prepare to celebrate Thanksgiving and the winter holidays.
Research shows such requirements have little effect on employment: Most working-age adults enrolled in these programs are already working, and those who are not employed often face high barriers such as caregiving responsibilities or health conditions. Instead, these requirements cause many people who should qualify for SNAP to lose benefits due to red tape and administrative error.
The GOP law also shifts SNAP costs onto states for the first time in the program’s history. This vital food program has always been fully federally funded, but the new budget will require states to take on a significant share of expenses. The unprecedented burden shift will likely lead many states to cut enrollees or even terminate food aid programs entirely for the first time since their inception, causing even more people to go hungry.
As the government resumes normal operations, the fight against hunger must continue. SNAP has long proven to be highly effective at reducing food insecurity and hunger, especially among children. We have the tools to fight hunger, and we must use them.
In the richest country in the world, no one should go hungry.
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Trump’s Big Bill Will Make It Harder for Doctors to Give Patients the Care They Need
Work requirements for Medicaid don’t encourage employment; they punish illness and make recovery harder.
Aug 22, 2025
Like most bright-eyed medical students entering the wards for the first time, I was eager to give my patients the best that modern medicine could offer. This is far from the reality that I was confronted with—one’s insurance status dictated care as much as any guideline, evidence, or well-intentioned physician ever could.
I cared for patients whose chronic illnesses forced them to stop working, only to be told that without a job, they no longer qualified for Medicaid. The logic is cruelly circular: Lose your health, lose your job, lose your care. Work requirements for Medicaid don’t encourage employment; they punish illness and make recovery harder.
Alongside countless peers and healthcare professionals, I was incredibly disheartened on July 4, 2025 as I watched US President Donald Trump sign into law the most sweeping healthcare overhaul since the Affordable Care Act. The 870-page One Big Beautiful Bill Act (OBBBA) is projected to strip health coverage from 11.8 million Americans, leading to an estimated 24,000 preventable deaths each year—driven largely by drastic changes to Medicaid’s administration.
The current administration has long touted work requirements as a fix to Medicaid, having approved 13 Medicaid Section 1115 demonstrations with work requirements in its first term. Unfortunately, it has ignored the failures of these waiver programs and doubled down, making ineffective work requirements the law of the land.
The Majority of Medicaid Recipients Are Already Working
President Trump and his administration have repeatedly stated that the integrity of the Medicaid program needs to be restored, promoting narratives of Medicaid waste, fraud, and abuse. As such, work requirements for “able-bodied” Medicaid recipients were a key provision in the OBBBA. However, in reality, 92% of Medicaid beneficiaries are already working, caring for family, attending school, or living with a disability. Only 8% are “able-bodied” adults not seeking employment.
States Have Tried Work Requirements, They Don’t Work
Arkansas was the only state to have a statewide Medicaid work requirement waiver approved. The results were catastrophic; over 18,000 beneficiaries lost coverage in the four months before a judge ruled that the program could not continue. While enacted, the waiver failed to increase employment; instead implementation was associated with increased Medicaid churn, medical debt, and loss of health coverage.
If the ability to work remains a prerequisite for care, I will spend my career watching patients suffer
For other states, like Michigan and New Hampshire, the path to work requirements was mired with legal challenges. Both states proposed work requirements, which would have resulted in nearly 80,000 and 17,000 beneficiaries losing coverage, respectively, had the programs not been suspended before taking effect.
As of July 2025, Georgia is the only state with active work requirements through the Pathways to Coverage program. Results of this program are similarly underwhelming, with only 8,000 enrolled as of June 2025 after two years of rollout and millions spent in administrative costs. Enrollment falls far short of the projected 64,000 enrollees or the 300,000 to 400,000 Georgians who would qualify for coverage under full Medicaid expansion.
The OBBBA Doubles Down on Failed Policy
The OBBBA will require all states to follow Georgia’s path by 2027. Based on Congressional Budget Office (CBO) estimates, the federal government will save $900 billion in Medicaid spending over the next decade, with work requirements accounting for a third of the reduced spending. These savings come at an enormous cost—approximately 5 million individuals are projected to lose access to Medicaid by 2034, 1.22 million jobs in the healthcare sector will vanish in the next decade, and unemployment will rise by 0.8%. The consequences of this bill will be devastating.
Medicaid Expansion is a Job Promotion Program
Overwhelming evidence suggests Medicaid expansion has reduced uninsurance rates, increased access to healthcare and pharmaceutical care, and improved health outcomes. Moreover, hospitals in expansion states have seen increased Medicaid revenue, decreased costs of uncompensated care, and states themselves have experienced reductions in disease-related deaths, and gains in life expectancy. Importantly, overwhelming evidence shows expansion has no negative effects on workplace engagement, and rather may help increase workplace success.
If the ability to work remains a prerequisite for care, I will spend my career watching patients suffer—not because I lack the skills to help them, but because the system forbids it. Practicing medicine under those rules doesn’t just make my job harder; it risks our patients losing faith in the system altogether.
The evidence is clear, we should be expanding Medicaid, not restricting it, for the good of our patients, our hospitals, and our country.
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'Extra Cruel': Trump Admin Ends Job Program for Seniors as Work Requirements Loom
"Many of our participants are living on the edge of poverty," said the head of one organization impacted by the termination of the Senior Community Service Employment Program.
Jul 20, 2025
The Trump administration has reportedly terminated the Department of Labor's only job training program for low-income seniors, a decision that came as older Americans braced for new work reporting requirements under the Republican budget law enacted earlier this month.
Bloomberg Law reported Friday that the Labor Department "quietly ended" its Senior Community Service Employment Program (SCSEP), which helped low-income Americans aged 55 or older find part-time employment or job training at nonprofits and government agencies. The program, described as a bridge to full-time employment, served tens of thousands of people across the country.
Groups that received funding under SCSEP, such as the National Council on Aging and Goodwill Industries, "say the program stopped giving them money after June 30," according to Bloomberg Law, which reported that the Labor Department "hasn't made available the roughly $300 million set aside for national grant recipients."
The Trump White House has proposed zeroing out funding for SCSEP in its budget request for fiscal year 2026, smearing the program as an "earmark to leftist, DEI-promoting entities."
In a July 17 letter to Labor Secretary Lori Chavez-DeRemer and Office of Management and Budget Director Russell Vought, a group of Democratic lawmakers led by Rep. Judy Chu (D-Calif.) warned that the withholding of SCSEP funds has already had "devastating impacts," pointing to program grantees in several states that have been forced to furlough thousands of low-income seniors.
Clayton Fong, president and CEO of the National Asian Pacific Center on Aging, said earlier this month that the funding delay "is not just a bureaucratic issue—it's a crisis for tens of thousands of older adults who depend on SCSEP to survive."
"Many of our participants are living on the edge of poverty," said Fong. "SCSEP gives them purpose, dignity, and the ability to put food on the table. The longer this delay continues, the deeper the harm is."
Bloomberg Law noted that the impact of the ending of SCSEP "could be particularly dire for the thousands of participants who will have to find work or volunteer hours to keep their public health insurance coverage."
"The cruelty is the point," former U.S. Labor Secretary Robert Reich wrote on social media in response to Bloomberg Law's reporting.
Just piling up the bad news today...Our nationwide job training program for low-income seniors has had bipartisan support for decades.It's extra cruel to end it right on the heels of new work requirements to access Medicaid and food assistance.
[image or embed]
— Alt U.S. Department of Labor (@alt-dol.altgov.info) Jul 18, 2025 at 10:15 AM
Millions of older Americans receive health coverage through Medicaid. The AARP Public Policy Institute has estimated that 9 million Medicaid recipients between the ages of 50 and 64 will be subject to the Trump-GOP budget law's work requirements, which mandate that certain enrollees engage in work, job training, or other qualifying activities for at least 80 hours per month—or lose coverage.
The mandates are set to take effect late next year, after the 2026 midterm elections.
The Republican law also expands work requirements for recipients of federal nutrition assistance, raising the age limit for the mandates from 55 to 64. Millions of older adults are enrolled in the Supplemental Nutrition Assistance Program nationwide.
"We believe every American deserves to age with dignity—and that requires affordable access to the basics of life such as food and healthcare," Ramsey Alwin, president and CEO of the National Council on Aging, said earlier this month after Republicans pushed the budget measure through Congress. "This act would put that further out of reach for millions of older Americans in need."
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Bill Would Subject Lawmakers to Same Work Reporting Mandates GOP Just Imposed on Medicaid, SNAP Recipients
"If congressional Republicans think these burdens are appropriate for struggling families, then members of Congress should shoulder them too," said BURDEN Act sponsor Rep. Raja Krishnamoorthi.
Jul 17, 2025
In response to Republicans' new law giving tax breaks to the rich while gutting the social safety net, U.S. Congressman Raja Krishnamoorthi on Thursday introduced legislation that would force members of Congress "to personally comply with the same burdensome work requirement paperwork they imposed on low-income Americans."
Under the Illinois Democrat's Bringing Unfair Reporting Duties to Electeds Now (BURDEN) Act, federal lawmakers "would be barred from enrolling in the Federal Employees Health Benefits Program unless they submit monthly proof of 'community engagement,' the same bureaucratic reporting required of Medicaid recipients," his office said.
Krishnamoorthi's two-page bill would also force members of Congress to file the same paperwork as Supplemental Nutrition Assistance Program (SNAP) recipients to verify eligibility, employment, and income. The proposal comes less than two weeks after President Donald Trump signed congressional Republicans' budget reconciliation package.
During the debate over the GOP megabill, Matt Bruenig, founder of the People's Policy Project, argued in The New York Times that "refusing medical care to people in their time of need based on how much they happened to work the month before is a cruel and pointless policy."
The so-called One Big Beautiful Bill Act is expected to leave 17 million Americans without health insurance, and, according to an Urban Institute analysis, an estimated 22.3 million families are projected to lose some or all of their SNAP benefits.
"President Trump's reckless 'Large Lousy Law' forces millions of vulnerable Americans to jump through hoops just to keep food on the table or get the medical care they need," Krishnamoorthi said in a statement. "If congressional Republicans think these burdens are appropriate for struggling families, then members of Congress should shoulder them too. The BURDEN Act simply says, if you want taxpayer-funded health coverage, prove you meet the same standards you're imposing on the American people."
Krishnamoorthi's bill is unlikely to go anywhere in either the House of Representatives or the Senate, both controlled by the GOP, but it sends a message to the public. His office said that "by exposing the double standard in how burdensome requirements are applied, the BURDEN Act seeks to restore basic fairness and highlight the real-world consequences of Republican policies that target working families."
He introduced the bill amid intense debates among Democratic politicians and their supporters about how to battle Trump and the GOP's agenda and prepare for the 2026 midterm elections, following devastating losses for Democrats in the last cycle.
On Wednesday, the Congressional Progressive Caucus—of which Krishnamoorthi is not a member—announced four task forces as part of an effort to "reclaim the House majority in 2026—with a sharp, populist, pro-working-class agenda that meets the moment."
Similarly but separately, a coalition of labor groups and other progressive organizations on Wednesday launched the Battleground Alliance PAC, a political action committee that plans to pour at least $50 million into flipping the lower chamber for Democrats.
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