Alliance Alert: The recent push in Congress to impose work requirements on Medicaid recipients is not only misguided—it’s dangerous. These proposals ignore the lived realities of millions of Medicaid enrollees, particularly those with mental health challenges, substance use disorders, and disabilities who rely on Medicaid for survival.
While proponents of the policy claim a moral imperative to encourage work, the truth is that most Medicaid recipients are already working, looking for work, caregiving, or managing serious health conditions. A new Urban Institute analysis confirms that of the nearly 5 million people expected to lose coverage under the proposed work requirements, only about 300,000 are not working by choice. The vast majority would lose coverage because of red tape, administrative hurdles, and system failures—not unwillingness.
Evidence from states like Arkansas, Michigan, and New Hampshire shows that Medicaid work requirements do not increase employment. Instead, they lead to massive coverage losses—even among people who are working—due to confusing policies and inadequate reporting systems. In Arkansas alone, over 18,000 people lost coverage in just seven months of implementation. Most were working or should have been exempt, but couldn’t navigate the bureaucracy.
Worse still, this policy push comes at the same time Congress is proposing devastating cuts to Medicaid and programs that actually help people work—such as Supported Employment and Individual Placement and Support (IPS). These proven models help people with disabilities secure and maintain jobs, fostering independence and reducing long-term reliance on public systems. Gutting them undermines any real effort to support work.
From the Bazelon Center’s recent analysis (full analysis attached):
- Nearly 40% of non-elderly Medicaid recipients have a mental health or substance use disorder.
- Work requirements would disproportionately harm these individuals—especially since three-fifths of disabled adult enrollees are not covered by SSI and would be subject to these rules.
- Rather than boosting work, work requirements strip people of the services that makes workingpossible, pushing many into crisis, institutionalization, or homelessness.
èƵand Recovery urges Congress to:
- Reject all Medicaid work requirements.
- Protect and fully fund Medicaid, the nation’s most important safety net for people with disabilities.
- Invest in voluntary, evidence-based employment supports like peer-led services, IPS, and Recovery Ready Workplace initiatives.
- Prioritize dignity, autonomy, and real opportunity over punitive and ineffective bureaucratic barriers.
We need your voice too!
You can support our efforts by taking two actions today:
Call 1-855-245-3682 to tell your Senators to Vote NO on the reconciliation bill unless these harmful cuts and changes to Medicaid are removed.
Message your congressmembers using our portal:
We don’t need policies that punish people for being poor or disabled—we need investments in what works. Let’s build systems that lift people up, not lock them out.
The Medicaid Work-Requirement Push
By Kelly Hooper | Politico | June 16, 2025
THE MEDICAID WORK EFFORT — Congressional Republicans are in lockstep on new Medicaid work requirements not only because they help generate savings for a spending package that extends President Donald Trump’s tax cuts but also because some of them say there is a moral imperative behind the proposed rules, POLITICO’s Robert King reports.
Many of them have long been skeptical about the Affordable Care Act’s Medicaid expansion, which enabled healthy adults to get Medicaid coverage if they earn up to 138 percent of the federal poverty level. Republicans have speculated that a sizable portion of new beneficiaries is not working and taking advantage of the coverage.
“We need to at least make an effort to try to help people, to get their life back together,” Sen. Jim Justice (R-W.Va.) said. “Will that result in a whole bunch of people who will lose their health insurance? I hope to goodness not.”
House Speaker Mike Johnson has said the only people who would lose coverage are those sitting around “playing video games all day.” Other Republicans have said the requirement tackles fraud.
But only about 300,000 of the nearly 5 million people expected to lose coverage if the new requirement becomes law as part of the House-passed GOP megabill refuse to work due to “lack of interest,” a new analysis from the left-leaning Urban Institute shows. That means people willing to work would lose coverage because they either cannot find work or because they cannot overcome administrative hurdles, experts said.
Background: The megabill would require able-bodied, working-age Medicaid recipients to work for 80 hours a month, but they could do volunteer work or go to school. Pregnant women and new mothers would be exempt.
Some of the critics of other megabill Medicaid provisions support work requirements, including Sen. Josh Hawley (R-Mo.). He wants to get rid of new cost-sharing obligations for beneficiaries and a freeze on states’ ability to levy provider taxes.
He has told reporters he is not concerned about the prospect of inadvertent coverage loss, adding that “we can sort that out.”
Even so: There could be a lot to sort out.
“People will have trouble successfully complying with the reporting requirements,” said Katherine Hempstead, senior policy officer for the Robert Wood Johnson Foundation, a liberal philanthropy that commissioned the Urban Institute analysis. “That is what we have found when we studied other states that put work requirements in Arkansas and New Hampshire.”
The nonpartisan Congressional Budget Office estimates that 18.5 million people would be subject to the work requirements each year and 4.8 million people would lose coverage by 2034 for noncompliance.
The estimate means that some people could lose coverage even if they meet the requirement, per the estimates from Urban and an earlier from the Brookings Institution.