House-Proposed Work Requirements Would Protect the Truly Needy, Reduce Dependency, and Grow the Economy
Key FIndings
- Most able-bodied adults on Medicaid do not work at all, despite millions of open jobs nationwide.
- The House of Representatives passed modest work requirements for some able-bodied adults on Medicaid. Under the proposal, able-bodied adults on the program would need to work just eight and a half hours per week at the average entry-level wage.
- Work is within reach for any able-bodied adult, with millions of open jobs across the country that require little to no training, education, or experience.
- Work requirements are an effective tool for moving people off welfare and increasing incomes while preserving resources for the truly needy.
Overview
Medicaid was designed to provide a safety net for truly needy Americans, including the elderly, children, and individuals with disabilities.1 However, ObamaCare expansion opened the door to a new class of able-bodied adults, leading to massive cost and enrollment overruns.2
Medicaid costs have exploded, and taxpayers are now on the hook for more than $900 billion per year.3 The primary driver of the growth in spending has been enrollment, as able-bodied adults have swelled the program. With no work requirements in place, the program encourages dependency and siphons resources away from the truly needy.
Work is essential to upward mobility and self-sufficiency. Yet labor force participation continues to trend downward, and businesses are facing worker shortages.4 Implementing Medicaid work requirements nationwide would boost the economy and promote self-sufficiency. Moreover, Medicaid work requirements are manageable, requiring just eight and a half hours per week at the average entry-level wage.5
Most able-bodied adults on Medicaid do not work at all, despite millions of open jobs nationwide
Employers are creating tens of thousands of jobs each month, yet many positions remain unfilled.6-7 Across the country, there are more open jobs than jobseekers looking for work.8-10 While it is a great time to find work, most able-bodied adults on Medicaid do not work at all.11
The lack of a work requirement in Medicaid encourages dependency. Since the passage of the Affordable Care Act, commonly known as ObamaCare, Medicaid enrollment has skyrocketed, driven by the enrollment of able-bodied adults.12 In 2000, fewer than seven million able-bodied adults were on the program.13 But by 2024, enrollment of able-bodied adults increased to a whopping 34 million.14 Nearly 85 percent of the program’s enrollment increase over the last decade is directly attributable to able-bodied adults.15
Spending on able-bodied adults now accounts for more than 35 percent of total Medicaid spending, more than what is spent on individuals with disabilities, the elderly, or children.16-17 Worse yet, Medicaid’s financing structure is designed to favor able-bodied adults over the truly needy, meaning Medicaid is no longer focused on the people the program was meant to serve.18
Groups aligned with the Left like to claim that most able-bodied adults on Medicaid are working.19-20 They also claim that work requirements are complex, confusing, and costly.21 These erroneous assertions are based on mathematically impossible extrapolations of survey responses, some with sample sizes of a few dozen people.22
Administrative data from state Medicaid agencies on tens of millions of able-bodied adult enrollees reveal such claims to be a lie.23 An alarming 62 percent of able-bodied adults on Medicaid have no earned income whatsoever.24 Moreover, with the average entry-level wage job starting at more than $15 an hour, even part-time work could put a single able-bodied adult above the poverty line or out of Medicaid eligibility entirely.25-27
Decreasing government dependency is good for everyone—able-bodied adults who return to work see bigger paychecks, the burden on taxpayers is reduced, and the truly needy are once again prioritized.
The House passed modest work requirements for some able-bodied adults. Under the proposal, able-bodied adults on the program would need to work just eight and a half hours per week at the average entry-level wage
The U.S. House of Representatives recently passed the One Big Beautiful Bill Act, which included modest work requirements for able-bodied adults on Medicaid.28 Enrollees can meet this requirement by working, participating in job training, or volunteering.29
Able-bodied adults enrolled on Medicaid who are physically and mentally fit for employment would be required to work, volunteer, or participate in job training for 80 hours per month.30 Anyone earning a monthly income equal to the federal minimum wage multiplied by 80 hours—$580 per month—would be automatically deemed in compliance the work requirement.31
With the average entry-level wage more than double the federal minimum wage, work requirements could be met by working much fewer hours. In fact, work requirements could be met by a single, able-bodied adult in just eight and a half hours per week at the average entry-level wage.32
Work is within reach for any able-bodied adult, with millions of open jobs across the country that require little to no training, education, or experience
Work is plentiful. There are millions of open jobs across the country, and wages are growing.33 The average entry-level wage nationwide is already more than $15 per hour, more than double the federal minimum wage.34 At this wage, work requirements could be met in just eight and a half hours per week of work.35
In some areas, the requirement could be satisfied with even less work. In Washington, D.C., for example, the average entry-level wage sits at $22.37.36 This means an able-bodied adult could satisfy the work requirement by working just six hours per week.37
Work puts people on a path towards self-sufficiency, but the benefits don’t end there. It can also lead to adults feeling more connected with their communities. Currently, non-working able-bodied adults on Medicaid spend an average of roughly 43 hours per week on leisure activities, including 29 hours per week watching TV or playing video games.38 To meet the proposed work requirement, these able-bodied adults would need to devote less than one-third of their current TV and video game time to work, providing them with an accessible and invaluable opportunity to contribute in a meaningful way to their families, communities, and country.
Additionally, newly created jobs increasingly require little to no experience.39 In fact, over the next decade, 86 percent of jobs created will require no experience, 71 percent will require a high school education or less, and 78 percent will require just one month or less of on-the-job training.40 This varies across states, but the trend is consistent nationwide.
The House-proposed work requirements are manageable and employment for able-bodied adults is attainable. At the typical entry-level wage, able-bodied adults can meet the requirement in roughly eight and a half hours of work per week.41
Work requirements are an effective tool for moving people off welfare and increasing incomes while preserving resources for the truly needy
Work requirements are extremely effective in moving able-bodied adults from welfare to work, ultimately leaving individuals better off.
When food stamp work requirements were implemented at the state level, able-bodied adults left welfare in record numbers to join the workforce.42-45 After entering the workforce, their incomes doubled within a year and tripled within two years.46 For example, in Missouri, able-bodied adults on food stamps fell by 85 percent within only one year of implementing work requirements.47 Within three months, incomes increased by 70 percent.48 In Florida, able-bodied adults on food stamps decreased by 94 percent after the state implemented work requirements.49 Floridians went to work in more than 1,100 industries.50
When states have implemented work requirements in Medicaid, earnings increased.Arkansas successfully implemented work requirements for a small portion of able-bodied adults in 2018.51
As a result, nearly 18,000 able-bodied adults left welfare due to higher incomes in just a few short months.52 When Tennessee moved 170,000 able-bodied adults off the Medicaid program, they saw an increase in employment, labor force participation, and job searches.53-54 Implementing work requirements for able-bodied adults on Medicaid will boost the economy and help transition people from dependency to self-sufficiency.
The Bottom Line: Congress should require able-bodied adults on Medicaid to work, train, or volunteer.
Able-bodied adults account for more than 35 percent of Medicaid spending, yet there is no expectation that these individuals work or even pursue skills that could lead to employment. Meanwhile, jobs requiring little to no experience are plentiful and wages remain high. Medicaid needs a reality check. The program is serving more individuals than it was designed for, at the expense of the truly needy.
The expectation that able-bodied adults do not need to work while on welfare creates a culture of dependency. Work, on the other hand, promotes self-sufficiency. The House bill contains modest work requirements that would move able-bodied individuals from welfare to work.
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