Sponsors (5)
The bill enforces an 80-hour engagement test that preserves coverage for those who comply and can reduce Medicaid costs, but it increases risks of disenrollment and wrongful denials for vulnerable people while raising administrative burdens and shifting costs to states.
Medicaid enrollees (low-income adults) who meet the 80-hour monthly engagement requirement will retain eligibility and federal-covered medical coverage.
States can use existing administrative databases first to verify compliance, reducing paperwork and documentation burden for many enrollees and simplifying some state processes.
States may remove noncompliant individuals from Medicaid rolls, potentially lowering state Medicaid expenditures and program costs.
Medicaid beneficiaries who fail the 3-month/80-hour engagement test — especially people with unstable or intermittent work, caregivers, and those facing short-term barriers — risk losing federal-covered medical benefits and being disenrolled.
Some exempt categories (e.g., students, people in treatment, people with disabilities) still require determinations and could be wrongfully denied coverage if verification fails, threatening rights and access.
Administrative costs and errors from tracking, verifying, and disenrolling enrollees could increase burdens on state agencies and on individuals trying to maintain coverage.
Based on analysis of 2 sections of legislative text.
Imposes an 80-hour/month Medicaid community engagement requirement and denies federal matching funds after three months of noncompliance, allowing states to disenroll affected individuals.
Introduced February 13, 2025 by Aaron Bean · Last progress February 13, 2025
Creates a new Medicaid “community engagement” requirement that generally requires 80 hours per month of work, community service, education, or equivalent earnings to maintain eligibility. If an eligible person fails to meet the requirement for three or more months in a calendar year while enrolled, federal matching funds (FFP) are unavailable for their medical assistance for those months. The law also lets states disenroll affected individuals for months when no FFP is available, establishes verification priorities using existing databases, and defines key terms such as “applicable individual,” “educational program,” and “work program.”