By Phil Galewitz, KFF Well being Information
Hundreds of thousands of Medicaid enrollees might have a manner out of the brand new federal work requirement — in the event that they stay in a county with excessive unemployment.
By January 2027, President Donald Trump’s far-reaching home coverage regulation would require many grownup, nondisabled Medicaid enrollees in 42 states and Washington, D.C., to work or volunteer 80 hours a month or go to highschool.
However beneath the regulation, Medicaid enrollees in counties the place unemployment is at the very least 8% or 1.5 occasions the nationwide unemployment price could possibly be shielded from the work requirement, if their state applies for an exemption.
A new evaluation by KFF reveals that exemption within the GOP’s work requirement may supply a reprieve to doubtlessly tens of millions of Individuals caught in a troublesome spot — needing to work to safe medical health insurance however having hassle discovering a job.
The Congressional Funds Workplace projected the work requirement would apply to 18.5 million Medicaid enrollees, inflicting about 5.3 million to lose their authorities well being protection by 2034. CBO spokesperson Caitlin Emma confirmed to KFF Well being Information that analysts factored the unemployment price exemption into their projections. Solely states that expanded Medicaid beneath the 2010 Reasonably priced Care Act or a particular waiver should enact a piece requirement, beneath the federal regulation.
However how many individuals could possibly be exempt is determined by how the Trump administration interprets the regulation, along with whether or not their states’ officers apply.
For instance, if Trump officers exempt folks in counties the place the unemployment price has been above the regulation’s thresholds for any month over a 12-month interval, about 4.6 million Medicaid enrollees in 386 counties may qualify for an exemption in the present day primarily based on the most recent unemployment knowledge, in response to KFF, a well being info nonprofit that features KFF Well being Information.
That quantities to only beneath 1 / 4 of all Medicaid enrollees topic to the work requirement.
Underneath that one-month threshold, “the impression could possibly be pretty important,” stated Jennifer Tolbert, a co-author of the evaluation and the deputy director of KFF’s Program on Medicaid and the Uninsured.
However, she stated, the Trump administration is extra prone to undertake a stricter threshold primarily based on common unemployment over a 12-month interval. That might align with work necessities beneath the federal Supplemental Diet Help Program, the meals help generally generally known as meals stamps.
Solely about 1.4 million Medicaid enrollees dwelling in 158 counties could possibly be exempted beneath that normal, or about 7% of the whole topic to work necessities, KFF discovered. That’s about 7% of enrollees who stay in enlargement states who would in any other case want to fulfill the brand new requirement.
Based mostly on the 12-month standards, about 90% of Medicaid enrollees who could possibly be exempted primarily based on excessive unemployment reside in 5 states, in response to KFF: California, New York, Michigan, Kentucky, and Ohio. California alone accounts for over half of those that could possibly be exempted.
The unemployment price exemption is certainly one of a number of carve-outs from the Medicaid work requirement within the GOP’s regulation. The regulation additionally exempts mother and father with youngsters beneath 14, people who find themselves disabled or frail, and those that are pregnant, incarcerated, or in a substance use dysfunction program, amongst others. The excessive unemployment provision is completely different than most as a result of it exempts folks dwelling in complete counties.
Two prime Republicans key to the invoice’s passage — Home Speaker Mike Johnson and Sen. Mike Crapo, chair of the Senate Finance Committee — didn’t reply to requests for remark.
To qualify for the Medicaid exemption, states must apply to the federal authorities on behalf of people in eligible counties. And if a county earned an exemption, the federal government would decide how lengthy it applies.
Even when the federal authorities grants exemptions broadly, well being advocates worry some Republican-led states may balk at making use of for exemptions with a purpose to maintain enrollment down, as they are saying has been the case with SNAP exemptions. As of 2023, 18 states didn’t have an exemption beneath the SNAP program, though a few of their residents is perhaps eligible.
“It’s not a assure that folks can depend on,” stated Emily Beauregard, govt director of Kentucky Voices for Well being, an advocacy group that intends to push for the broadest potential exemptions to assist folks preserve their protection. Japanese Kentucky has a number of counties with perennially excessive unemployment.
In advocating for Trump’s invoice, many Republicans in Washington argued that most individuals who gained Medicaid advantages beneath the Reasonably priced Care Act needs to be working to get off of presidency help.
However as Georgia’s and Arkansas’ experiences have proven, Medicaid work necessities might be pricey for states to run and irritating for enrollees to navigate. About 18,000 folks in Arkansas, or practically 1 / 4 of the state’s adults who gained Medicaid protection by the ACA enlargement, misplaced protection when the state had a piece requirement in 2018 and 2019. A court docket ended the state’s work requirement program.
Critics level out that most Medicaid enrollees already work or have a incapacity or caregiving tasks, they usually argue the reporting necessities merely function a bureaucratic hurdle to acquiring and conserving protection. Underneath the GOP regulation, enrollees’ work standing must be verified at the very least twice a 12 months.
A lot of the protection losses as a consequence of work necessities happen amongst individuals who work or ought to qualify for an exemption however nonetheless lose protection as a consequence of purple tape, analysis reveals.
Not each state should implement a piece requirement beneath Trump’s regulation, solely those who selected to increase Medicaid protection to extra low-income folks by the ACA or a federal waiver. The ACA has offered a whole bunch of billions in federal {dollars} to assist states cowl everybody making as much as 138% of the federal poverty degree — $21,597 for a person in 2025.
Forty states and Washington, D.C., took up the enlargement. Georgia and Wisconsin partly expanded their Medicaid eligibility by getting a federal waiver, including them to the listing of states topic to the work requirement. These two states weren’t included within the KFF evaluation due to an absence of county-level enrollment knowledge.
Jennifer Wagner, director of Medicaid eligibility and enrollment on the left-leaning Heart on Funds and Coverage Priorities, stated she is happy the regulation makes some exceptions for locations the place jobs are scarce. It may restrict how many individuals lose protection due to the work requirement, she stated.
Wagner stated SNAP’s unemployment price exemption has helped tens of millions of individuals keep away from dropping their meals help, however its impression additionally is determined by whether or not a state seeks the waiver.
She is worried the Trump administration might make it troublesome for counties to get exempted beneath the Medicaid regulation.
“I’m glad it’s in there as it should definitely assist folks, however it’s nonetheless a horrible invoice,” she stated. “This is not going to actually blunt the hurt of the invoice.”
©2025 KFF Well being Information. Distributed by Tribune Content material Company, LLC.
Initially Revealed:
