House Republicans Unveil Medicaid Bill with Work Requirements

If passed, a massive change could be in store for the 71 million Americans on Medicaid, with House Republicans introducing a bill that would require many enrollees in the government health care program to prove they are working, volunteering, or in school to receive coverage. The proposal is part of an effort by House Republicans to find $880 billion in savings over the next decade to help pay for President Trump's tax bill, which includes extending his 2017 tax cuts and introducing some new reductions.

Key Takeaways:

• The proposed bill would require Medicaid recipients to prove they are working, volunteering, or in school to receive coverage, with a "community engagement requirement" mandating at least 80 hours of community engagement per month.
• Approximately 5.2 million people aged 19-55 could lose coverage if federal work requirements go into effect for Medicaid, according to an April 2025 estimate from the Urban Institute.
• The bill would also introduce a more rigorous income verification process for those who enroll in the Affordable Care Act's health care coverage, with applicants required to prove their income level.
• Medicaid recipients who make more than 100% of the federal poverty level would be required to pay out-of-pocket costs for some services, with fees limited to $35 per visit.
• The bill targets immigrants living in the U.S. illegally or without documentation, reducing the federal government's share of Medicaid funding for states that allow such individuals to enroll by 10%.
• The requirements would take effect on January 1, 2029, and would affect many vulnerable Americans, including those with disabilities and serious health conditions.
• Some policy experts and Democrats in Congress warn that slashing Medicaid would hurt many Americans, with millions likely to lose coverage if the bill passes, while also posing a financial risk to some hospitals that rely on the program.

Statistics:

• 5.2 million people aged 19-55 could lose coverage if federal work requirements go into effect for Medicaid, according to an April 2025 estimate from the Urban Institute (Urban Institute, 2025).
• 92% of people under 65 years old who aren't receiving disability benefits were working full- or part-time in 2023, or else unable to work because of duties such as attending school or caregiving obligations (KFF, 2023).
• 18,000 adults lost coverage after work requirements were implemented in Arkansas, with more than half of those reporting that they delayed medical care and more than 6 in 10 saying they delayed taking medications because of cost (Harvard University's T.H. Chan School of Public Health, 2020).
• Georgia's Pathways to Coverage program has fallen short of enrollment goals, partly because of the administrative hurdles involved in verifying employment as well as technical glitches (Pro Publica, 2023).

Sources:

• Urban Institute (2025). "Work Requirements in Medicaid: An Update on Current Status and Implications."
• KFF (2023). "Most Working-Age Adults Who Receive Medicaid or CHIP Are Working."
• Harvard University's T.H. Chan School of Public Health (2020). "Arkansas' Medicaid Work Requirements Have Serious Consequences for Low-Income Adults."
• Pro Publica (2023). "How a Government Program Intended to Help Low-Income Georgians Has Failed Them."
• Medicaid and CHIP Payment and Access Commission (2023). "Medicaid Work Requirements: A Review of the Literature and Policy Implications."