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Work Requirements Might Cut Medicaid Spending. But at What Cost?聽
The Week in Brief

Work Requirements Might Cut Medicaid Spending. But at What Cost?聽

Republicans have long pushed to force working-age adults enrolled in Medicaid to show they are, in fact, working. 

Party members argue Medicaid, a taxpayer-funded program for people with low incomes and disabilities, shouldn鈥檛 cover Americans who aren鈥檛 actively trying to improve their financial situations. And Republicans are to achieving a national work requirement, after winning the White House and both chambers of Congress, and unlocking a fast-track process to secure big spending cuts.聽

A national Medicaid work requirement would slash spending by reducing the number of people covered. About 5 million adults in 2026 if Congress imposes one. 

But here鈥檚 the thing: Most adults with Medicaid who can work are already working, or have some reason they can鈥檛 (such as they鈥檙e full-time caregivers). And the experiences of two states that have implemented work requirements reveal the hidden costs of adding those layers of bureaucracy.  

The nonpartisan U.S. Government Accountability Office confirmed last week that, at the request of three Democratic senators, it鈥檒l examine the costs of running a work requirement program that Georgia spent millions of dollars to establish. 

The GAO investigation comes at a critical time, said Leo Cuello, a research professor at Georgetown University鈥檚 Center for Children and Families. 

鈥淐ongress seems to be pursuing cuts in Medicaid in a frenetic and rushed manner,鈥 he said. The GAO report could outline for Congress the full extent of problems with work requirements 鈥渂efore they rush forward and do this without thinking.鈥 

The GAO previously found that work requirement programs can be extremely expensive for states to run 鈥 鈥 and that federal officials failed to consider those costs when approving the programs, which are not allowed to increase Medicaid spending. 

States must introduce new technology and have enough staffers to verify whether enrollees meet complex eligibility requirements and to monitor their continued compliance. 

When Arkansas tried its work requirement program, which applied to those covered by Medicaid expansion, 18,000 people lost coverage in less than a year before a federal judge stopped it. 

So, yeah, a work requirement would cut federal spending, but potentially also anger voters. 

New polling released Thursday by 麻豆女优, a nonprofit health policy organization that includes 麻豆女优 Health News, shows 鈥 regardless of party 鈥 oppose funding cuts to Medicaid. 

Moderate Republicans are showing trepidation about changes to the program: House Republican Don Bacon, a key centrist from Nebraska, he wouldn鈥檛 support more than half a trillion dollars in cuts to Medicaid over a decade. The House-passed version of a congressional budget resolution called for as much as $880 billion. 

While Donald Trump has emphasized his goal of rooting out waste in federal programs, he鈥檚 also asking Congress to extend his 2017 tax cuts and spend more on border security. 

That the opinion of one House member from Nebraska could draw so much attention this week underlines the hard math House Speaker Mike Johnson faces in passing those pricey priorities; he can鈥檛 lose more than a handful of GOP votes to get it done.

Government Watchdog Expects Medicaid Work Requirement Analysis by Fall

This fall, the U.S. Government Accountability Office expects to release a report on how much it costs to run Georgia Pathways to Coverage 鈥 the country鈥檚 only active Medicaid work requirement program 鈥 as other states and Congress consider similar programs.

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