Research Note: Most Medicaid Enrollees Work, Refuting Proposals to Condition Medicaid on Unnecessary Work Requirements

The latest data for 2023 continue to show that nearly 2 in 3 Medicaid enrollees work, and most of the rest have a disability, are caring for family members, or are attending school (Figure 1). Despite the fact that the majority of Medicaid enrollees work, recent Republican health coverage proposals have called for taking Medicaid away from people who don’t meet burdensome and unnecessary work requirements.^[1] The evidence is clear: Medicaid work requirements lead to large coverage losses, as enrollees are caught up in administrative burdens and red tape.^[2]The evidence is clear: Medicaid work requirements lead to large coverage losses, as enrollees are caught up in administrative burdens and red tape.

Medicaid work requirement proposals sometimes exempt certain populations, such as people with disabilities, students, and people with caregiving responsibilities. The data show that if these groups were exempted, only a small share of enrollees remains who neither already work nor qualify for an exemption. Yet past experience shows that large numbers of enrollees who work or qualify for an exemption would nevertheless lose coverage due to administrative burdens.^[3]

The chart below excludes adults under age 65 who receive Supplemental Security Income (SSI) or Medicare, groups that likely qualify for Medicaid based on disability. But it is not safe to assume that people enrolled in Medicaid through the program’s disability pathway would be safe from work requirements — indeed, a 2023 Republican bill passed by the House would have required even people enrolled through a disability pathway to submit medical paperwork from a physician proving that they’re “unfit for employment.”^[4]

Moreover, research shows that work requirements do not increase employment.^[5] The Congressional Budget Office concluded that the 2023 House bill — which by a conservative estimate would put over 10 million people’s coverage at risk — would lead to coverage loss with “no change in employment or hours worked.”^[6] Work requirements are rooted in stereotypes based on race, gender, disability status, and class, not in reality. They ignore the instability of low-paying jobs, ongoing labor market discrimination that limits employment opportunities for people of color and women, the lack of child care and paid sick and family leave, and the impact of health conditions, disabilities, and the need to care for family members on people’s ability to work at various times.^[7]

People’s access to health care shouldn’t hinge on whether they meet work requirements or successfully navigate a complicated system to report work hours or claim an exemption.^[8] Work requirements are unnecessary, harmful, and can’t be fixed — policymakers should reject them.^[9]