Half of Medicaid beneficiaries could lose coverage if Medicaid work requirements in the ‘One Big Beautiful Bill’ are extended nationally
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04811
A cross-sectional study suggests that if Congress were to impose Medicaid work requirements across the country, roughly half of adult enrollees could be at risk of losing coverage despite having higher rates of physical, cognitive, and daily‑living impairments. Researchers found that many of these adults report poor overall health, even though their impairments may not qualify them for formal disability exemptions. The study is published in Annals of Internal Medicine.
The One Big Beautiful Bill Act (H.R.1) implemented Medicaid work requirements for beneficiaries in some states, but congressional policymakers are considering extending work requirements nationally to all Medicaid enrollees. Researchers from Beth Israel Deaconess Medical Center’s Richard A. and Susan F. Smith Center for Outcomes Research analyzed data from the 2022–2023 Medical Expenditure Panel Survey to understand the health and functional status of adults aged 19 to 64 who did not meet typical exemption criteria and worked less than 20 hours a week who could lose Medicaid if federal work requirements were implemented. They found that about 8.3 million people, or 50.4% of this group, would be at risk of disenrollment. These adults had higher levels of physical, neuropsychological, and independent‑living impairments, and were more likely to report poor physical and mental health compared with those meeting work requirements. The authors conclude that many enrollees vulnerable to losing coverage have health challenges significant enough to limit their ability to meet work-hour rules, even if they do not qualify as formally disabled. The findings underscore the importance of revising exemption criteria to account for functional impairment and medical vulnerability.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Rishi K. Wadhera, MD, MPP, MPhil please email rwadhera@bidmc.harvard.edu.
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Journal
Annals of Internal Medicine
Method of Research
News article
Subject of Research
Peopl
Article Publication Date
31-Mar-2026
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