Many low-income Americans who rely on Medicaid due to chronic illnesses or disabilities are voicing deep concerns over a proposed medicaid work requirement included in President Trump’s “One Big Beautiful Bill Act.” The legislation aims to enforce that Medicaid recipients in 40 states and Washington, D.C., either work, volunteer, or attend school for at least 80 hours per month, or regularly prove exemption status through paperwork.
For individuals like Stephanie Ivory of Columbus, Ohio, and Denise Sommer of Warrenton, Missouri, this proposal feels burdensome. Ivory, 58, suffers from gastrointestinal conditions and a bulging disc, rendering her unable to work. While she believes she’d qualify for an exemption, she worries about the difficulty of navigating additional reporting requirements. “It’s hard enough just renewing Medicaid every six months,” she said.
Sommer, also 58, who has not worked in five years due to anxiety and arthritis, believes she could qualify with a doctor’s note. While she supports the idea of limiting Medicaid abuse, she downplayed concerns about others potentially losing coverage, suggesting it’s their responsibility to stay informed.
The Policy and Its Potential Impact of Medicaid Work Requirement
The proposed medicaid work requirement is a key element in the GOP’s broader legislative agenda. Supporters, including House Speaker Mike Johnson, argue that it would preserve Medicaid for those “who rightly deserve it,” and encourage able-bodied individuals to join the workforce. Johnson recently claimed that 4.8 million enrollees are choosing not to work—a statement that health policy experts contest.
However, research from the Urban Institute and KFF shows that over 90% of working-age Medicaid recipients are already employed, actively seeking work, in school, or unable to work due to caregiving responsibilities or disability. Many of those who do work hold low-wage jobs that do not offer employer-sponsored health insurance.
The Congressional Budget Office (CBO) estimates that the House bill’s work requirement could lead to 5 million people losing Medicaid by 2034, with projected savings of $300 billion over a decade. The Senate version may affect an additional 380,000 people. Critics say the financial savings come at the cost of healthcare for the most vulnerable.
Red Tape and Real-World Consequences
Advocates and analysts warn that the practical implications of enforcing these requirements could mirror past failures in states like Arkansas and Georgia, where similar policies were introduced. In Arkansas, the online exemption process proved so complex that many eligible individuals lost coverage due to technical difficulties or confusion. In Georgia, Medicaid applicants must first enter job-training programs before applying for exemptions—a process that can delay or deny critical care.
Stephanie Carlton, of the Centers for Medicare & Medicaid Work Requirement Services, defended the policy, claiming that improved digital tools would make compliance easier. She framed the change as a way to foster community engagement. Yet, critics like Leslie Dach of Protect Our Care argue that the policy ignores the unpredictability of real-life employment and healthcare needs. “If you miss one month, you’re kicked off,” Dach warned.
Michael Karpman of the Urban Institute emphasized that red tape—not lack of willingness—is often the reason people lose coverage. With more than 20% of adult Medicaid recipients living with disabilities, even minor bureaucratic missteps could result in major healthcare disruptions.
As the bill moves forward, many fear that those who need Medicaid the most—like Chris Bryant, a disabled Kentuckian living on federal aid—could face unnecessary and life-threatening hurdles. “It’s going to be messy,” he said. “People are on Medicaid because they have no other option.”
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