Want to See Why the GOP Medicaid Work Requirements Are a Disaster? Look to Arkansas |
As I noted in an article earlier this month, the Congressional Budget Office (CBO) estimates that the federal government will save $911 billion over 10 years and that 10 million people will lose health insurance as a result of Medicaid changes in H.R.1, aka the One Big Beautiful Bill Act (OBBBA). This bill requires near-poor, able-bodied Medicaid beneficiaries with incomes currently above the poverty line but under thresholds that depend on family size — $22,025 for an individual or $45,360 for a family of four — to navigate a maze of red tape and reporting requirements twice a year to remain enrolled. Disabled people on Medicaid, including those with cancer or end stage renal disease, will have to prove that they are too disabled to work in order to waive the work requirement.
An analysis by health policy organization KFF found that in 2023, 64 percent of adults 19 to 64 years of age enrolled in Medicaid were working either full or part-time. Nearly 30 percent were not working because of caregiving responsibilities, disability or school attendance — barriers to employment that typically exempt people from work requirements in programs that mandate them. Most of the 8 percent who were not working were retired or unemployed. The result is that only a small share of Medicaid enrollees will lose access to the program because they do not meet work requirements. However, many more will lose coverage because of the difficulty of navigating the reporting requirements and the administrative red tape built into the OBBBA for this purpose.
In June 2026, HHS released interim regulations for the changes to Medicaid that states must implement by January 1, 2027. The regulations are much more severe than the requirements in H.R.1, and have upended work that states had already done to be ready to comply by the January 1 deadline. This has forced states to scramble to be ready in just six months, an extraordinarily short window to prepare for the large changes in reporting requirements. Disenrolling people by mistake may mean the difference between life and death for Medicaid enrollees. The rollout of the new work and massively burdensome reporting requirements is likely to be bumpy.
ASPE Publishes Very Brief Fantastical Briefing Report
In conjunction with the release of the new eligibility and reporting requirements, the Department of Health and Human Services released a brief, prepared by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), with the Orwellian title, “Medicaid Work Requirements Incentivize Employment and Are Estimated to Reduce Poverty.” The brief’s conclusion that pushing people off the Medicaid rolls will increase employment and reduce poverty is contradicted by an earlier assessment by the Congressional Budget Office (CBO). CBO found that mandating work requirements would decrease what the federal government pays for Medicaid, increase the number of people without health insurance, raise costs for states, and wouldn’t increase employment.
The four-and-a half page ASPE brief has few citations for its assertions about how cutting access to health insurance for poor people will magically produce jobs for those disenrolled from Medicaid. While the authors say they have reviewed three decades of literature on work requirements in social programs, and they have an online bibliography with more than 130 references, they cite only 10 papers in the brief. As NOTUS observes, the researchers that produced the 10 papers cited in the brief are crying foul, claiming that their studies are being misused, and in some cases are being used to support conclusions that are the opposite of what the studies show. In other cases, researchers complain that while the findings of their studies may not be distorted, crucial job search supports for job seekers in their studies that are not available to people facing disenrollment from Medicaid in 2027 are ignored in the ASPE brief.
As noted in a technical analysis of the ASPE brief published in Health Affairs, the brief assumes totally unrealistic employment effects. It considers two scenarios. In the first, all 5.8 million people on Medicaid — who the brief assumes will not meet the new work requirements and are not exempt from them — will........