Medicaid Work Requirements Mirror Programs in Georgia, Arkansas: Ciara Zachary, PhD, MPH

Ciara Zachary, PhD, MPH, assistant professor in the Department of Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina, discussed what the work requirements introduced in the One Big Beautiful Bill Act will mean for those who receive their coverage through Medicaid, including how work requirements had been attempted in states like Georgia and Arkansas.

Transcript

Can you explain the Medicaid work requirements and who stands to be the most affected by this change?

These work requirements from the House Reconciliation or HR 1 will really target our Medicaid expansion population. If we all recall, one of the critical provisions of the Affordable Care Act was to expand Medicaid for adults under age 65 up to 138% of the federal poverty level. For some of these folks, there's a tendency to be on 2 different sides of the coin. Some folks believe everyone deserves access to health care. Others believe that some folks are more deserving than others. And so with this expansion population, we're kind of thinking, if these are adults, many of whom are not caregivers or parents, that they should be working. So that is kind of what's behind the work requirement.

This would require folks in the Medicaid expansion population to prove that either they are looking for a job, working, or maybe participating in some kind of educational or skill-building activity for about 80 hours a month, and the states would have to determine whether folks are meeting these benchmarks or proving that they've had 80 hours of work a month, I believe every 6 months, to determine whether they are still eligible.

Many people say that what was in the Big Beautiful Bill Act with work requirements is kind of modeled after what's happening in Georgia. Now, I believe they have a program with work requirements called Pathways to [Coverage], and that's kind of the thing. They are working 80 hours a month and having to submit paperwork.

I think what's important to note is that the GAO [Government Accountability Office] report from September about the Georgia Pathways work requirement, and even what we knew a few years ago during the first Trump administration when Arkansas briefly had work requirements, is that it makes it harder for people to get Medicaid coverage. And it actually is an extreme administrative burden and costly administrative burden. So I would say those are the main points: that it's actually not really going to increase access to care, and it's actually going to create lots of barriers for those who would be eligible in that Medicaid expansion population, but also create just administrative burden for states.