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Introduced February 6, 2025 by Daniel Crenshaw · Last progress February 6, 2025
Allows states to make able-bodied adults ineligible for Medicaid for any month they fail a new monthly work or volunteer requirement, starting January 1, 2026. The requirement is a monthly average of at least 20 hours per week of paid work or volunteering, and the bill defines who counts as an "able-bodied adult" by listing exclusions (young, elderly, pregnant people, primary caregivers of young or seriously ill children, those medically unfit, certain unemployment recipients, and people in specified substance-use treatment).
This bill trades the potential for modest increases in work or volunteer participation and greater state flexibility for Medicaid eligibility against a high risk that vulnerable low-income people — especially those with irregular jobs, caregiving duties, or intermittent health conditions — will lose coverage, shifting costs to hospitals and increasing administrative burdens on states.
Some low-income Medicaid adults may increase work or volunteering to maintain eligibility, potentially improving employment skills and community engagement.
State governments gain flexibility to set and enforce eligibility rules, allowing tailored program administration to local circumstances.
Low-income adults on Medicaid — including people with intermittent disabilities or chronic conditions — risk losing coverage if they cannot meet the 20-hour monthly work/volunteer requirement or if exemptions are narrowly interpreted.
Parents, caregivers, and people with unstable or irregular work schedules are disproportionately likely to lose Medicaid coverage because the monthly-hour requirement does not account for irregular hours or caregiving responsibilities.
Removing coverage from affected beneficiaries could shift costs to hospitals and health systems, increasing uncompensated care and raising healthcare costs for local communities.