Medicaid Work Rule Sparks Fears of Loss \ Newslooks \ Washington DC \ Mary Sidiqi \ Evening Edition \ President Donald Trump’s proposed legislation would impose work requirements on many Medicaid recipients. Critics say it could jeopardize coverage for millions, especially the sick and disabled. The bill, aimed at reducing government spending, faces growing backlash from beneficiaries and health policy experts.
Quick Looks
- Trump-backed bill adds work requirement to Medicaid eligibility
- Proposal targets able-bodied adults under Medicaid expansion
- Exceptions include age, disability, caregiving, pregnancy, emergencies
- 71 million currently enrolled in Medicaid; 5 million may lose coverage
- Critics cite risks of administrative errors and paperwork burdens
- Some with serious conditions worry they won’t qualify for exemptions
- KFF: work rules in other states didn’t increase employment
- Concerns rise as July 4 deadline for Senate vote approaches
Deep Look
Crystal Strickland spent years navigating red tape to finally secure Medicaid coverage for a chronic heart condition. Now, the 44-year-old North Carolina resident fears that lifeline could be pulled out from under her. Under a new bill pushed by President Donald Trump—dubbed the “Big Beautiful” bill—many adults on Medicaid could lose coverage unless they meet newly proposed work requirements.
“What sense does that make?” she asks. “What about the people who can’t work but can’t afford a doctor?”
The proposed legislation, which cleared the U.S. House and is now under Senate consideration, seeks to slash federal spending and taxes while reshaping the country’s social safety net. A major component would mandate that able-bodied adults work, volunteer, or attend school at least 80 hours per month to qualify for Medicaid—unless they fall under specific exemptions.
Those exceptions cover children, seniors, pregnant women, people with disabilities, primary caregivers of young children, and individuals recently released from incarceration or during declared emergencies. Still, the bill applies to adults enrolled under Medicaid expansion, adopted by 40 states under the 2010 Affordable Care Act.
Critics warn the policy could lead to large-scale coverage losses not due to ineligibility, but because of paperwork and procedural complications. For people like Strickland—who has struggled with homelessness and relies on discarded food for sustenance—any added barriers could be devastating.
Steve Furman, a retired father of a 43-year-old man with autism, worries the new requirements will jeopardize his son’s access to essential care. Although his son likely qualifies for a disability exemption, Furman notes how hard it already was to get him on Arizona’s Medicaid system after relocating in 2022. “Should I expect the government to take care of him?” he asks. “I don’t know, but I do expect them to have humanity.”
Medicaid currently serves around 71 million Americans. According to a May KFF poll, 92% of adult Medicaid recipients are already working, attending school, or caring for others—or are disabled. The Congressional Budget Office estimates 5 million people could lose coverage under the proposed rule, many of them due to administrative barriers.
Analyst Amaya Diana from KFF points to past examples in Georgia and Arkansas, where similar work requirements failed to increase employment but succeeded in reducing enrollment. “Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern,” said Amber Bellazaire of the Michigan League for Public Policy.
Virginia Bell, a Mississippi retiree, said she doesn’t oppose work requirements in principle but doubts they can be fairly enforced. “It’s kind of hard to determine who needs it and who doesn’t,” she said, recalling a relative who died recently after being unable to access Medicaid coverage.
Lexy Mealing of New York was diagnosed with breast cancer in 2021 and now works occasional gig jobs while still recovering. She relies on Medicaid for ongoing treatment, including surgeries and follow-up care. The idea that she might be denied coverage because she can’t meet the 80-hour work threshold terrifies her.
“I can’t even imagine going through treatments and surgeries and then not having insurance because I don’t work enough,” she said.
Felix White, a 61-year-old diabetic in Pennsylvania, echoed that fear. Out of work since being laid off as a programmer, Medicaid now pays for the insulin, glucose monitor, and foot surgeries that keep him alive. “There’s no way I could have afforded that,” he said. “I would have lost my foot and probably died.”
Proponents of the bill argue that work requirements are essential to preserve Medicaid for the truly needy and prevent fraud. Yet opponents argue that such policies place undue burden on vulnerable populations and risk undermining public health.
With the Senate set to take up the bill ahead of a July 4 deadline, pressure is mounting. Advocates are urging lawmakers to reconsider or amend the legislation to avoid unintended consequences that could destabilize lives and increase strain on hospitals and clinics already serving at-risk communities.
As the political debate intensifies, millions of Medicaid recipients across the U.S. are left wondering whether their lifeline to health care will hold—or slip away under new red tape.
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