Sponsors (5)
The bill conditions Medicaid on verifying 80 hours of work/earnings or service to encourage work and curb improper payments, but it risks cutting coverage for hard-to-document and medically vulnerable people while raising privacy and uneven state-implementation concerns.
Low-income adults who meet the 80-hour work/earnings or approved service requirement: retain Medicaid coverage, creating a clearer incentive to maintain workforce activity.
State governments: can remove noncompliant enrollees from Medicaid rolls, which can reduce improper payments and lower some state administrative/benefit costs.
Low-income adults who fail to verify 80 hours (or miss documentation deadlines): risk losing Medicaid coverage, increasing uninsured rates and likely raising their out-of-pocket and uncompensated care costs.
People with intermittent work, irregular hours, unstable housing, or medical conditions/disabilities: are disproportionately likely to fail to meet or document the 80-hour requirement or face delayed exemption determinations, leading to higher rates of wrongful disenrollment.
Low-income enrollees subject to verification via third-party databases: face privacy risks and potential administrative errors that could wrongly terminate coverage.
Based on analysis of 2 sections of legislative text.
Creates an 80‑hour/month Medicaid community engagement requirement and makes federal matching funds unavailable after three months of noncompliance, allowing state disenrollment.
Official title: To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program.
Introduced February 13, 2025 by Aaron Bean · Last progress February 13, 2025
Creates a new Medicaid “community engagement” work requirement for many non‑elderly, non‑disabled adults and lets states stop receiving federal matching funds (FFP) for months when an eligible adult fails to meet the requirement for three or more months in the same calendar year. States would be allowed to disenroll individuals from Medicaid for months where no federal matching is available. The requirement generally is 80 hours/month of work, community service, or comparable activity, with certain categories (children, seniors, pregnant people, full‑time students, many caregivers, and people medically exempt) excluded. The change alters federal matching rules to permit denial of FFP for medical assistance for noncompliant individuals and adds detailed verification, exemption, and earnings definitions. It shifts compliance and administrative responsibilities to states and could reduce Medicaid coverage for affected low‑income adults who do not meet the participation test or fail documentation requirements.