A massive change could soon be in the works for the 71 million Americans on Medicaid, with House Republicans unveiling new legislation on Sunday that would require many enrollees in the government health care program to prove they are either working, volunteering or in school to receive coverage.
The proposal is part of an effort by House Republicans to find $880 billion in savings over the next decade to help pay for President Trump’s tax bill, which will extend his 2017 tax cuts while introducing some new reductions, like eliminating taxes on tips.
Because President Trump has vowed not to touch Medicare — the health insurance program for people 65 and older — Republican lawmakers have turned their sights to Medicaid, which provides health coverage for low- and middle-income households. GOP lawmakers contend that Medicaid should be scrutinized because it’s prone to financial waste, and that, by doing so, the program will be better able to serve the people who need it.
“Medicaid is hugely problematic because it has a lot of fraud, waste and abuse,” House Speaker Mike Johnson, a Republican from Louisiana, said in February. Rooting out waste “preserves the programs, so it is available for those who desperately need it.”
Some policy experts and Democrats in Congress warn that slashing Medicaid would hurt many vulnerable Americans, with millions likely to lose coverage if the bill passes, while also posing a financial risk to some hospitals that rely on the program.
“[Nowhere] in the bill are they cutting ‘waste, fraud, and abuse’ — they’re cutting people’s health care and using that money to give tax breaks to billionaires,” said Rep. Rep. Frank Pallone of New Jersey, the top Democrat on the Energy and Commerce Committee, which oversees health care spending, in a May 12 statement about the new bill.
The House Republican bill could change considerably as it moves through the legislative process. More than a dozen House Republicans have told Johnson and GOP leaders they will not support cuts to the health care safety net programs that their constituents depend on.
“Community engagement requirement”
Under the House bill, many Medicaid recipients would be subject to something the measure calls a “community engagement requirement.” That provision would mandate that people who are enrolled in the program either work, participate in volunteer work or be enrolled in an educational program for at least 80 hours a month.
Medicaid recipients also would have to verify their community engagement eligibility twice a year. The bill also adds a more rigorous income verification process for those who enroll in the Affordable Care Act’s health care coverage.
If the bill is passed, the requirements would take effect Jan. 1, 2029.
Republicans have previously sought to tie receiving government benefits to work requirements, with one GOP lawmaker in 2023 seeking to tighten these rules for the food-stamp program because he said believed that “work is the best pathway out of poverty.”
Some policy experts who study Medicaid, food stamps and other social safety net programs say that there’s little evidence that work requirements increase employment, partly because most people who receive such aid and who are able to work are already doing so.
About 92% of people under 65 years old who aren’t receiving disability benefits were working full- or part-time in 2023, or else unable to work because of duties such as attending school or caregiving obligations, according to a recent analysis from heath publication KFF. The remaining 8% were either retired, couldn’t find work or weren’t working for another reasons.
Two states — Georgia and Arkansas — have added work requirements for Medicaid recipients, although Arkansas dropped the mandate after a court struck it down in 2019, a year after it was implemented.
Bumped off the rolls
A 2020 analysis of Arkansas’ work requirements found that 18,000 adults lost coverage after the policy went into effect, with more than half of those reporting that they delayed medical care and more than 6 in 10 saying they delayed taking medications because of cost. The requirements didn’t boost employment, the study, by researchers at Harvard University’s T.H. Chan School of Public Health, also found.
Georgia maintains a work requirement for a Medicaid expansion program called Pathways to Coverage, which provides insurance to some low-income adults who wouldn’t otherwise qualify for coverage. But that program has fallen short of enrollment goals, partly because of the administrative hurdles involved in verifying employment as well as technical glitches, according to a Pro Publica report.
“[W]ork requirements are the worst sort of red tape — blocking health coverage for working people, people with serious health conditions and people with disabilities,” said Laura Harker, a senior policy analyst at the Center on Budget and Public Policies, a public policy think tank, in a December post about Georgia’s program.
An April 2025 estimate from the Urban Institute finds that as many as 5.2 million people ages 19- to 55-years-old could lose coverage if federal work requirements go into effect for Medicaid.
Other cost-cutting measures
Some Medicaid recipients who make more than 100% of the federal poverty level — about $32,000 a year for a family of four — would be required under the House GOP bill to pay out-of-pocket costs for some services. Those fees, which would not apply to emergency room visits, prenatal care, pediatric visits or primary care check-ups, would be limited to $35 per visit.
And applicants could not qualify for Medicaid if they have a home that is valued at more than $1 million.
The proposed bill also targets any immigrants who are living in the U.S. illegally or without documentation. It reduces by 10% the share the federal government pays to states that allow those immigrants to sign up for Medicaid, such as California or New York. To qualify for Affordable Care Act coverage, enrollees would have to prove they are “lawfully present.”
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