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Conditions federal Medicaid matching funds on most adults meeting a new monthly "community engagement" requirement of 80 hours of work, community service, or training (or equivalent earnings). If an eligible adult fails this requirement for 3 or more months in a calendar year, the federal government would not pay its share of medical assistance for those months and states would be allowed to disenroll the person for months with no federal match. The law defines who is exempt (children, seniors, pregnant people, caretakers, those medically unfit, students enrolled half-time, people in treatment programs, and others), requires states to use existing databases first to verify compliance, and adopts a definition of work and work programs consistent with rules used in other federal programs. States would have to implement verification systems and could choose to remove noncompliant beneficiaries from their programs when federal matching dollars are not available.
The bill trades potential incentives for work and reduced paperwork against a high risk that vulnerable Medicaid recipients will lose coverage or face administrative errors, shifting costs to individuals and health systems.
Low-income adults on Medicaid may be encouraged to increase work hours or community engagement via an 80-hour monthly requirement, potentially increasing employment and earnings for some beneficiaries.
States can verify compliance using administrative databases before contacting individuals, which may reduce paperwork and administrative burden for beneficiaries and state agencies.
Medicaid beneficiaries who cannot meet or document an 80-hour monthly work/service threshold — including people with unstable jobs, caregivers, those with disabilities that are not formally documented, and those facing transportation or childcare barriers — risk losing federal-funded coverage or being disenrolled, increasing uninsured rates.
States may be incentivized to remove or terminate coverage for noncompliant beneficiaries to avoid costs, shifting expenses onto individuals, hospitals, and emergency care systems and increasing uncompensated care.
Relying on administrative databases for verification risks erroneous eligibility terminations if records are incomplete, outdated, or mismatched, which can interrupt access to necessary care.
Introduced February 13, 2025 by Aaron Bean · Last progress February 13, 2025