Introduction to Medicaid Work Requirements
By Rae Ellen Bichell and Sam Whitehead, KFF Health News
This summer, the state of Louisiana texted just over 13,000 people enrolled in its Medicaid program with a link to a website where they could confirm their incomes.
The texts were part of a pilot run to test technology the Trump administration says will make it easier for some Medicaid enrollees to prove they meet new requirements — working, studying, job training, or volunteering at least 80 hours a month — set to take effect in just over a year.
But only 894 people completed the quarterly wage check, or just under 7% of enrollees who got the text, according to Drew Maranto, undersecretary for the Louisiana Department of Health.
The Challenge of Verifying Eligibility
“We’re hoping to get more to opt in,” Maranto said. “We plan to raise awareness.”
The clock is ticking for officials in 42 states — excluding those that did not expand Medicaid at all — and Washington, D.C., to figure out how to verify that an estimated 18.5 million Medicaid enrollees meet rules included in President Donald Trump’s tax and spending law. They have until the end of next year, and federal officials are giving those jurisdictions a total of $200 million to do so.
The policy change is one of several to free up money for Trump’s priorities, such as increased border security and tax breaks that mainly benefit the wealthy.
The Impact of Work Rules on Medicaid Enrollees
The nonpartisan Congressional Budget Office has said the work rules will be the main reason millions of people won’t be able to access health insurance over the next decade. It estimates changes to the Medicaid program will result in 10 million fewer Americans covered by 2034 — more than half of them because of the eligibility rules.
For now, state officials, health policy researchers, and consumer advocates are watching the pilot program in Louisiana and another in Arizona. Mehmet Oz, director of the Centers for Medicare & Medicaid Services, has touted those test-drives and said they will allow people to verify their incomes “within seven minutes.”
“There have been efforts to do this in the past, but they haven’t been able to achieve what we can achieve because we have technologies now,” said Oz, during a television appearance in August.
The Role of Technology in Verifying Eligibility
Brian Blase, the president of the conservative Paragon Health Institute and a key architect of Medicaid changes in the new law, has chimed in, saying during a recent radio appearance that with today’s artificial intelligence “people should be able to seamlessly enter how they are spending their time.”
KFF Health News found scant evidence to support such claims. Federal and state officials have offered little insight into what new technology the two pilots have tested. They do say, however, that it connects directly with the websites of Medicaid enrollees’ payroll providers, rather than using artificial intelligence to draw conclusions about their activities.
Concerns About the Effectiveness of Pilot Programs
Oz said the Trump administration’s efforts started “as soon as the bill was signed” in July. But work on the pilot programs began under the Biden administration.
And Medicaid is a state-federal program: The federal government contributes most of the funds, but it is up to the states to administer them, not the federal government.
“Oz can say, ‘Oh no, we’re going to fix this. We’re going to do this.’ Well, they don’t actually run the program,” said Joan Alker, a health policy researcher at Georgetown’s Center for Children and Families.
The Need for More Information and Transparency
Officials have also offered few details about the pilots’ effectiveness in assisting enrollees in Medicaid or other public benefit programs.
The shortage of information has some state officials and health policy researchers worried that the Trump administration lacks viable solutions to help states implement the work rules. As a result, they say, people with a legal right to Medicaid benefits could lose access to them.
“What actually keeps me up at night is the fear that members that are eligible for Medicaid and are trying to get health care services would fall through the cracks and lose coverage,” said Emma Sandoe, Oregon’s Medicaid director.
Conclusion
State officials and health policy researchers said neither pilot program could confirm whether a person meets other qualifying activities — such as community service — or any of the numerous exemptions. The tools being tested can verify only income.
Andrew Nixon, director of communications for the U.S. Department of Health and Human Services, which oversees Oz’s agency, wrote in a statement that the digital tools officials aim to share with states “are largely under development.”
One person doing that development is Michael Burstein, a software engineer who, until recently, worked at the U.S. Digital Service, which later became known as the Department of Government Efficiency.
FAQs
Q: What are the new work requirements for Medicaid enrollees?
A: The new requirements include working, studying, job training, or volunteering at least 80 hours a month.
Q: How will the work requirements be verified?
A: The verification process is still being developed, but it is expected to involve digital tools that connect with the websites of Medicaid enrollees’ payroll providers.
Q: What is the concern about the work requirements?
A: The concern is that people with a legal right to Medicaid benefits could lose access to them due to the lack of viable solutions to help states implement the work rules.
Q: How many people are expected to be affected by the work requirements?
A: An estimated 18.5 million Medicaid enrollees will be affected by the work requirements.
Q: What is the deadline for states to implement the work requirements?
A: States have until the end of next year to implement the work requirements, but they can ask for an extension until the end of 2028 with the approval of HHS Secretary Robert F. Kennedy Jr.
©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.
