The Republican’s “big beautiful” budget package would add new work requirements for millions of Americans who rely on Medicaid and food stamps. Tying federal aid in exchange for work is “common sense,” according to House Speaker Mike Johnson, who said it would encourage people to get jobs.
While the food stamp program already has a work requirement, the GOP bill tightens the regulation for beneficiaries, requiring those who are so-called “able-bodied adults without dependents,” or ABAWDs, to prove they’re working up to age 64, up from the current threshold of 54 years old.
Taken together, the new requirements would add reporting requirements for millions of low-income Americans, who would need to prove they’re working or else volunteering or enrolled in an educational program to qualify for health care or food assistance. Republican lawmakers say it makes sense to tack on these restrictions to ensure that people aren’t “gaming the system,” in Johnson’s words, while also encouraging them to seek employment.
There are millions of people on Medicaid “right now nationwide who are able-bodied workers, young men, for example, who are not working, who are taking advantage of the system,” Johnson told CBS News’ “Face the Nation” on May 25.
“The One, Big, Beautiful Bill’s work requirements — which include activities such as volunteering, job training, or looking for a job — are commonsense reforms that are overwhelmingly popular among the American people,” a White House official told CBS MoneyWatch. “These reforms will not only address waste, fraud and abuse, but protect and preserve Medicaid for the Americans whom the program was intended to serve as a lifeline for: seniors, disabled individuals, and low income families.”
About two-thirds of Americans back work requirements for SNAP and Medicaid, according to a 2023 Axios poll.
Growing body of research
Work requirements were first introduced into the Supplemental Nutrition Assistance Program (SNAP) — the formal name for the food-stamp program — under President Bill Clinton. And two states, Arkansas and Georgia, have in recent years introduced work requirements for Medicaid recipients, although Arkansas dropped its plan after a judge blocked it in 2019.
That’s allowed economists and policy experts to study work requirements and how they have impacted people who rely on food assistance and public health insurance. So far, there’s little evidence to show work requirements boost employment among the low-income Americans who rely on the programs.
Instead, some recipients end up losing their benefits after work requirements are introduced due to administrative hurdles of proving employment, failure to find enough work to qualify, or other issues like disability or illness, experts told CBS MoneyWatch.
Take a 2019 research paper published by the National Bureau of Economic Research, which examined what happened when Virginia reinstated work requirements for some food stamp recipients in 2013. The researchers found that after work requirements went into effect, SNAP enrollment of people who were subject to the regulation dropped by about 50%.
“But it did not lead to any meaningful increase in employment or earnings on average,” Adam Leive, an assistant professor at the Goldman School of Public Policy at University of California, Berkeley, and a coauthor of the paper, told CBS MoneyWatch. “And so, what we instead found was that work requirements largely functioned as a way to remove people from the program, but without improving their employment prospects.”
He added, “Our results probably provide some evidence as to what would be expected in Medicaid.”
The GOP budget measure passed in the House in May with a one-vote margin, solely with Republican votes. On Tuesday, the Senate Finance Committee unveiled its portion of the bill. While it changes some of the House version’s provisions, it continues to include the Medicaid work requirement for adults between 19 to 64 who aren’t disabled and don’t have children.
The Senate Committee on Agriculture, Nutrition and Forestry’s portion of the bill, also released Tuesday, maintains the House version’s higher age threshold for the food stamp program.
Medicaid and work
About 18.5 million Medicaid recipients, or roughly 1 in 4 enrollees, would be subject to the new work requirement if the GOP package becomes law, according to a June 4 analysis by the nonpartisan Congressional Budget Office. Of those, roughly 4.8 million people are likely to lose health insurance due to the new policy, it projected.
“Research and real-world experience both show that work requirements don’t help people find or maintain work,” wrote Allie Gardner, a senior policy analyst at the Center for Budget and Policy Priorities, a policy think tank, in a June 12 research report.
The new Medicaid work requirements would be particularly stringent, she added. First, the provision would deny coverage to applicants who can’t show they’re already working, volunteering or enrolled in an educational program for 80 hours a month before they are enrolled.
States, which administer Medicaid to their residents, would be permitted to block enrollment to people who can’t show they have already had months of work under their belt, she added. States could also require people to verify their employment as frequently as once per month, and require up to six months of consecutive work to keep their Medicaid enrollment, she said.
The two states that have sought to introduce work requirements for Medicaid enrollees have had mixed results. In Arkansas, about 18,000 adults lost coverage in the first four months after the policy went into effect, out of the state’s roughly 800,000 enrollees. More than half of those reported they delayed medical care and more than 6 in 10 said they delayed taking medications because of cost, according to a 2020 analysis by researchers at Harvard University’s T.H. Chan School of Public Health.
The requirements didn’t boost employment, the researchers also found.
Burdensome requirements
Georgia is the only state with a current work requirement for Medicaid, offering a program targeted to certain low-income adults who wouldn’t otherwise qualify. Like the GOP budget bill’s provision, Georgia requires beneficiaries to perform 80 hours a month of work or other activities, such as volunteering or schooling.
But that program has cost the state $86 million while enrolling 6,500 people in its first 18 months, far short of enrollment goals, partly because of the administrative burdens of verifying employment as well as technical glitches, Pro Publica has reported.
One enrollee, BeShea Terry, 51, told the Associated Press that maintaining her standing in the program has been difficult, including encountering numerous erroneous messages that she hadn’t uploaded proof of her work hours. When her coverage was mistakenly canceled in December, it took months of calls to a caseworker and visits to a state office to resolve, she said.
“It’s a process,” she said. “Keep continuing to call because your health is very important.”
Georgia Gov. Brian Kemp’s administration has defended the program as a way to transition people to private health care. At least 1,000 people have left the program and obtained private insurance because their income increased, according to the governor’s office.
Older Americans at risk
Some policy experts are particularly concerned about the bill that would require people up to age 64 to prove they’re working in exchange for food aid or health insurance because older Americans can face greater employment struggles due to ageism, health issues or needing to care for an ill spouse or relative.
The SNAP program’s current work requirement only applies to people up to age 54.
If the bill’s higher age threshold is enacted, about 1 million Americans between 55 to 64 would be at risk of losing food stamps, according to the CBPP.
“It’s so much harder at that age to find a job, based on age discrimination, outdated skills and you may have health issues that don’t rise up to a full disability,” Salaam Bhatti, director of the SNAP program at the Food Research & Action Center, an anti-hunger advocacy group, told CBS MoneyWatch.
He added, “What it ultimately does is just remove them from the program that’s helping them put food on the table.”
Some advocacy groups for older Americans are urging lawmakers to rethink hiking SNAP’s work requirement to age 64, as well as adding the employment requirement for Medicaid.
“We oppose efforts to add new burdens that could cost people their health care coverage not because they are ineligible, but because they missed a deadline or could not navigate a complex system,” wrote AARP President Nancy LeaMond in a May 21 letter to Johnson and House Minority Leader Hakeem Jeffries.
The higher age limit for SNAP’s work requirements “is especially harmful to older adults who often face age discrimination, longer unemployment, chronic health conditions and caregiving responsibilities that limit their ability to stay in the workforce,” she added.
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