The political logic of Medicaid work requirements is simple and emotionally resonant: taxpayer-funded healthcare should go to people who are trying to support themselves, not to people who are capable of working and choosing not to. The problem with this logic is that it describes a population that research consistently shows is tiny relative to the Medicaid population — and that work requirements, as implemented, don't effectively target that population anyway.
Who Is Actually on Medicaid.
According to Kaiser Family Foundation analysis of Medicaid enrollment data, roughly 64 percent of non-elderly Medicaid adults who are not already exempt (due to disability, caregiving, or other factors) are already working. Of the remaining 36 percent who are not working, a significant portion are out of work due to illness, caring for a family member, attending school, or actively seeking employment. The share who are able-bodied, of working age, and simply not working by choice is a small fraction of total enrollment — not the majority that work requirement rhetoric implies.
What Happened in Arkansas.
Arkansas became the first state to implement Medicaid work requirements, in 2018 under a Trump administration waiver. The results were studied extensively. Within months, approximately 18,000 people had lost Medicaid coverage. Researchers from Harvard and Georgetown published a study in the New England Journal of Medicine finding that the requirement did not increase employment — the employment rate among affected Arkansans did not change — but did significantly increase the uninsured rate. Most people who lost coverage did not find jobs. They just became uninsured. A federal court struck down the requirements, finding they were inconsistent with Medicaid's core purpose.
The Arkansas experience is the closest thing to a controlled real-world experiment on work requirements that exists. Its findings — no employment gains, significant coverage losses, primarily affecting people who were working or had legitimate exemptions but couldn't navigate the reporting requirements — have been replicated in analysis of other states' work requirement implementations.
The Second Term Push.
The Trump administration's second term included significant efforts to expand Medicaid work requirements nationally, as part of the broader effort to reduce Medicaid spending. The "One Big Beautiful Bill" budget reconciliation package that moved through Congress in early 2025 included work requirement provisions. The CBO estimated that Medicaid work requirements would reduce enrollment by millions of people — not because those people would find employment, but because they would fail to satisfy reporting requirements or would be disenrolled during administrative processes.
The 64 percent working figure is from Kaiser Family Foundation analysis, publicly available at kff.org. The Arkansas work requirements study was published in the New England Journal of Medicine (Sommers et al., 2019). The federal court ruling striking down Arkansas requirements was in Gresham v. Azar, decided by US District Court for DC. CBO estimates of coverage losses under work requirement proposals are from publicly available CBO analyses.
- Kaiser Family Foundation — Medicaid enrollment and work status analysis; kff.org; publicly available.
- Sommers et al. (2019) — "Medicaid Work Requirements — Results from the First Year in Arkansas," New England Journal of Medicine; peer-reviewed.
- Gresham v. Azar — US District Court for DC; Arkansas work requirements struck down as inconsistent with Medicaid's purpose.
- Congressional Budget Office — coverage loss estimates for Medicaid work requirement proposals; cbo.gov.
- Georgetown University Center for Children and Families — analysis of work requirement implementation impacts.