How Work Requirements Would Affect Medicaid Coverage in Each Expansion State

The Issue

Researchers analyze policy proposals that would withhold federal funding for adults enrolled in Medicaid expansion who do not report working for at least 80 hours per month or meet exemption criteria, such as being a student, family caregiver, or having a disability. A previous Urban Institute analysis shows that about 5 million adults nationwide could lose Medicaid coverage under such a requirement. This analysis breaks down these coverage losses by state and region.

Key Findings

• At least 10,000 adults would lose coverage in nearly every expansion state.
• Coverage losses would be highest in states with large populations like California (1–1.2 million) and New York (743,000–846,000) and would number more than 100,000 in Arizona, Illinois, Indiana, Kentucky, Louisiana, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania, and Washington.
• Researchers say coverage losses could vary widely based on state Medicaid programs’ administrative capacity and how they choose to implement requirements, as well as details of the final federal legislation and regulatory guidance.

Conclusion

Researchers say nearly all people who would lose coverage under a federal Medicaid work requirement are already working, engaged in work-related activities, or meet exemption criteria.

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.