Introduction to Medicaid Work Requirements
Now that the Republicans’ big tax-and-spending bill has become law, new bureaucratic hurdles have emerged for millions of Americans who rely on Medicaid for health coverage. A provision in the new law dictates that, in most states, for the first time, low-income adults must start meeting work requirements to keep their coverage. Some states have already tried doing this, but Georgia is the only state that has an active system using work requirements to establish Medicaid eligibility — and recipients must report to the system once a month.
The Challenges of Meeting Work Requirements
When she first started using the system, Tanisha Corporal, a social worker in Atlanta, wasn’t opposed to work requirements — in principle. But when she left her job at a faith-based nonprofit to start her own project, the Be Well Black Girl Initiative, she needed health coverage. She soon came face-to-face with how daunting it can be to prove you are meeting the state’s work requirements. Corporal has been a social worker for more than two decades in Georgia and was familiar with the state’s social service programs. For years, it had been her job to help others access benefit programs. But her challenges with paperwork and the process had only begun.
The Red Tape of Medicaid Eligibility
Health advocates point to Georgia’s system as a sign that the new law will lead to excessive red tape, improper denials, and lost health coverage. Beginning in 2027, the law will require adults on Medicaid who are under 65 to report how they engaged in at least 80 hours per month of work, education, or volunteer activities. Alternatively, these adults could submit documentation showing they qualify for an exemption, such as being a full-time caregiver. Most states will have to set up verification systems similar to Georgia’s, which can be expensive to implement and run. In the two years since launching its program, Georgia has spent more than $91 million in state and federal funds, according to state data. More than $50 million of that was spent on building and operating the eligibility reporting system. Right now, just under 7,500 people are enrolled in Georgia.
The Struggle to Maintain Coverage
For Corporal, 48, forgoing coverage wasn’t an option. She had been diagnosed with pre-diabetes and had other medical concerns. “I have breast cancer in my family history,” she said. “So it was like, I gotta get my mammograms.” On paper, it looked as if she qualified for Georgia’s program, called Georgia Pathways to Coverage. It offers Medicaid to adults — who otherwise wouldn’t qualify for traditional Medicaid in Georgia — with incomes up to the federal poverty level ($15,650 per year for an individual, or $26,650 per year for a family of three), as long as they can show that for at least 80 hours a month they’re working, attending school, training for a job, or volunteering. Corporal was eager to apply. She was already volunteering at least that much, including with the nonprofit Focused Community Strategies, and helping with other South Atlanta community improvement efforts.
The Frustration of Dealing with Bureaucracy
Corporal gathered up the various documents and forms needed to verify her duties and volunteer hours, then submitted them through Georgia’s online portal. “And we were denied. I was like, this makes no sense,” said Corporal, who has a master’s degree in social work. “I did everything right.” In the end, it took eight months fighting to prove that she and her son, a full-time college student in Georgia, qualified for Medicaid. She repeatedly uploaded their documents, only for them to bounce back or seemingly disappear into the portal. She went through numerous rounds of denials and appeals. Corporal recently pulled up one of the denial notices on her cellphone to read aloud: “Your case was denied because you didn’t submit the correct documents. And you didn’t meet the qualifying activity requirement,” she read from the email.
The Concerns of Health Advocates
Health advocates point to Georgia’s system as a sign that the new law will lead to excessive red tape, improper denials, and lost health coverage. “In Georgia, we have seen that people just can’t get enrolled in the first place. And some folks who do get enrolled lose their coverage because the system thinks they didn’t file their paperwork or there’s been some other glitch,” said Laura Colbert, who leads the advocacy group Georgians for a Healthy Future. Another state, Arkansas, tried work requirements in 2018. But it didn’t go any better there, said Joan Alker, who leads the Center for Children and Families at Georgetown University. “A lot of the problems were similar to Georgia,” she said, “in terms of the website closed at night, people couldn’t get a hold of people.”
The Rationale Behind Work Requirements
Some Republicans who backed the spending and tax legislation said the idea behind the national Medicaid work mandate was to ensure that as many people as possible who can work, do work. And to eliminate what the Trump administration deems waste, fraud, and abuse. “What we’re doing is restoring common sense to the programs in order to preserve them because Medicaid is intended to be a temporary safety net for people who desperately need it,” U.S. House Speaker Mike Johnson said during a June appearance on “The Megyn Kelly Show.” “You’re talking about the elderly, disabled, you know, young single pregnant moms who are down on their luck, right? But it’s not being used for those purposes because it’s been expanded under the last two Democrat presidents and to cover everybody. So, you’ve got a bunch of able-bodied young men, for example, who are on Medicaid and not working. So what we’re doing is restoring work requirements to Medicaid. OK, this is common sense.”
The Effectiveness of Work Requirements
National work requirements are unlikely to actually boost employment, Alker said, because more than two-thirds of Medicaid recipients ages 19-64 already have jobs. The remainder includes students, or those who are too sick or disabled to work. “Work requirements don’t work, except to cut people off of health insurance,” she said. The logistical steps required to report one’s activities assume that a recipient has reliable internet or transportation to travel to an agency — things that low-income Georgians may not have. The paperwork requirements to gain coverage are time-consuming, said one Medicaid recipient, Paul Mikell. Mikell is a licensed truck driver but does not have coverage through that job. He’s also an electrician who currently does property maintenance in exchange for free housing.
Conclusion
The implementation of work requirements for Medicaid recipients is a complex and contentious issue. While some argue that it is necessary to ensure that able-bodied individuals are working and not relying on the system, others point out that it can lead to excessive red tape, improper denials, and lost health coverage. The experience of Tanisha Corporal and others in Georgia highlights the challenges of navigating the system and the frustration of dealing with bureaucracy. As the new law takes effect, it is essential to consider the potential consequences and ensure that the system is simplified and accessible to all who need it.
FAQs
Q: What are the new work requirements for Medicaid recipients?
A: Beginning in 2027, adults on Medicaid who are under 65 will be required to report how they engaged in at least 80 hours per month of work, education, or volunteer activities.
Q: How will the work requirements be verified?
A: Most states will have to set up verification systems similar to Georgia’s, which can be expensive to implement and run.
Q: What are the concerns of health advocates regarding the work requirements?
A: Health advocates point to Georgia’s system as a sign that the new law will lead to excessive red tape, improper denials, and lost health coverage.
Q: How effective are work requirements in boosting employment?
A: National work requirements are unlikely to actually boost employment, as more than two-thirds of Medicaid recipients ages 19-64 already have jobs.
Q: What are the potential consequences of the work requirements?
A: The work requirements can lead to excessive red tape, improper denials, and lost health coverage, particularly for low-income individuals who may not have reliable internet or transportation to travel to an agency.
By Jess Mador, WABE, KFF Health News
Originally Published: August 12, 2025 at 12:10 PM EDT
©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.
