Congressional Bill Proposes First-Ever Federal Medicaid Work Requirements

A sweeping legislative proposal titled the “One Big Beautiful Bill Act” is moving through Congress with a provision that could lead to millions losing Medicaid coverage due to new work requirements.

Both House and Senate versions of the bill include measures mandating that adults aged 19 to 64 work or participate in qualifying activities for at least 80 hours per month to maintain eligibility for Medicaid. Exemptions may apply to individuals with dependent children or specific medical conditions, but experts warn these may not be sufficient to prevent coverage loss.

Doctor holding money and a pill bottle | Source: Pexels

“There’s no question that millions of people will be harmed,” said Allison Orris, senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities.

According to the Congressional Budget Office (CBO), approximately 4.8 million additional individuals could become uninsured by 2034 as a direct result of the proposed Medicaid work requirements. When combined with other policy shifts—such as the expiration of enhanced Affordable Care Act (ACA) tax credits—the number of uninsured could reach 16 million by that year.

The proposed work requirements represent the largest Medicaid cost-saving measure in the House bill, projected to cut federal spending by $344 billion over 10 years, according to KFF, a nonprofit health policy research group.

Doctor | Source: Pexels

Current law prohibits tying Medicaid eligibility to employment. However, states can impose work requirements through federal waivers. Georgia currently enforces such a policy, and several other states have submitted waiver requests.

“If denied coverage under Medicaid work rules, individuals would also be barred from receiving subsidized marketplace insurance,” Orris noted.