Congress' 'big beautiful' bill proposes new Medicaid work requirements. Here's what to know
The "One Big Beautiful Bill Act" that is making its way through Congress may put millions of people at risk of losing access to Medicaid.
One reform that may prompt that loss of coverage — the implementation of new work requirements — was included in both the Senate and House versions of the bill.
In 2034, about 4.8 million additional people would be uninsured based on work requirements in the House Republican budget bill, according to the Congressional Budget Office, a nonpartisan legislative scorekeeper.
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"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.
Overall, 16 million individuals may be uninsured by 2034, according to CBO, based on the combined effects of the House Republicans' budget bill on Medicaid and Affordable Care Act coverage; the expiration of enhanced premium tax credits tied to the ACA; and a separate rule proposed by the Trump administration targeting ACA marketplaces.
The House and Senate versions of the "big beautiful" bill would impose federal work requirements on Medicaid for the first time.
Per the House and Senate proposals, individuals ages 19 to 64 who apply for Medicaid or who are enrolled through Affordable Care Act expansion group would need to would need to work or participate in qualifying activities for 80 hours per month.
Adults may be exempt if they have dependent children or have qualifying circumstances such as medical conditions; however, "exemptions don't always work, and people could lose coverage anyway," Orris said.
Medicaid work requirements proposed in the House bill would cut federal spending by $344 billion over 10 years, representing the legislation's largest source of Medicaid savings, according to KFF, a nonprofit provider of health policy research.
Current law prohibits basing Medicaid eligibility on work requirements or work reporting requirements, according to KFF.
"Many people on Medicaid, if they're able to, are already working," said Robin Rudowitz, director of the program on Medicaid and the uninsured at KFF.
However, some states may implement work requirements if they receive approval through waivers. Georgia is currently the only state with a Medicaid work requirement. "Several" other states have recently submitted waiver requests to put such requirements in place, according to KFF.
Arkansas previously implemented Medicaid work requirements. However, estimates have shown while more people became uninsured because of that policy, there were not meaningful increases in employment, according to Rudowitz.
The Senate version of the bill introduced a "harsher" take on the work requirements that would apply to some parents, Orris said. The Senate calls for limiting parental exemptions to those with children ages 14 and under, rather than all parents of dependent children as the House proposed.
Individuals who apply for Medicaid coverage would need to meet work and other requirements for one or more consecutive months before they apply. Eligibility redeterminations would be conducted at least twice per year to ensure enrollees still meet those requirements.
The Senate version proposes capping the look-back period for showing compliance with work requirements to three months, which on net may be helpful to people, Orris said.
If an individual is denied coverage or disenrolled because they do not meet the Medicaid work requirements, they would be ineligible for subsidized marketplace coverage.
The Senate bill also allows for a longer timeline for states to comply with the Medicaid work requirements. The chamber's bill would give states the ability to ask for a good faith waiver that would give them an additional two years to come into compliance with the provision, or until the end of 2028, rather than the end of 2026 in the House version.
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