Study: Nearly two-thirds of Medicaid beneficiaries already work

Republicans are considering implementing work requirements for the safety-net insurance program — linking beneficiaries’ eligibility to work, education or volunteer hours — as they look to fund President Trump’s promised tax cuts. A previous proposal to add work requirements to Medicaid would save the federal government $109 billion over 10 years, according to the Congressional Budget Office.  

However, most Medicaid beneficiaries are already working — and their likelihood of being employed is often related to demographic and external factors, according to KFF. 

For example, seven in 10 enrollees between the ages of 30 and 39, with a college degree and in excellent health were working. In comparison, sicker, older and less educated enrollees were notably less likely to be employed. 

Many Medicaid beneficiaries also don’t have access to employer-sponsored health insurance. Nearly 50% of Medicaid beneficiaries worked at companies with less than 50 employees, which aren’t penalized under the Affordable Care Act for failing to provide healthcare coverage to workers. 

Additionally, many Medicaid beneficiaries who worked part time faced barriers to full-time employment. Twenty-two percent cited family or personal obligations that hindered their ability to work full time, while 9% pointed to childcare challenges. 

Despite interest from conservatives, Congress has never enacted Medicaid work requirements into law, and the policies have only rarely been pursued by states. 

Though a number of states received waivers from the CMS during the first Trump administration to put together their own programs, the vast majority of experiments were struck down by courts and never went into effect. President Joe Biden rescinded Trump’s approvals when he took office in 2021. 

Arkansas was the only state to implement a work requirement during the first Trump administration before it was halted by a court ruling. Nearly a quarter of the people subject to the work requirement, or 18,000 beneficiaries, lost coverage.  

Though most of the coverage losses were reversed after the program was struck down, many who lost insurance later struggled to pay off medical debt or delayed care due to cost, according to a 2020 study published in Health Affairs. And the requirements didn’t ultimately increase employment as intended. 

One program in Georgia is currently active, after Gov. Brian Kemp, a Republican, sued the Biden administration so it could go into effect.  

The state partially expanded Medicaid in 2023 as long as those enrollees met work requirements. 

But the expansion hasn’t met enrollment expectations. About 5,500 people were covered as of November 2024, far fewer than 240,000 uninsured people who were estimated to be eligible, according to the Center on Budget and Policy Priorities.