• Arkansas, Ohio, and Arizona are pursuing Medicaid work requirements, with Arizona also proposing a five-year lifetime limit on benefits for some adults.
• Critics argue that work requirements may lead to significant coverage loss due to paperwork burdens and do not significantly increase employment.
• Legal challenges are expected, focusing on whether work requirements align with Medicaid's primary objective of providing healthcare coverage.

Several states are revisiting or implementing Medicaid work requirements, which mandate that certain able-bodied adults must work a specified number of hours to maintain their health insurance coverage. This initiative, popular among Republicans, aims to reduce government spending and encourage self-sufficiency. However, concerns are mounting regarding the potential for widespread coverage loss, particularly among vulnerable populations who may struggle with reporting requirements or face unstable employment. Arizona's proposal to impose a five-year lifetime limit on Medicaid benefits for non-working adults adds another layer of complexity and potential legal challenges.

• What: States are reviving or introducing Medicaid work requirements, with Arizona seeking a five-year lifetime limit on benefits.
• Who: Key individuals involved include Arkansas Governor Sarah Huckabee Sanders, Gideon Lukens (Center for Budget and Policy Priorities), Trevor Hawkins (Legal Aid of Arkansas), and Tonya Moore (Health Management Associates). Organizations include the Centers for Medicare & Medicaid Services (CMS), Congressional Budget Office (CBO), Urban Institute, and Robert Wood Johnson Foundation.
• When: The proposals are being considered and implemented in 2025. Arkansas' previous work requirement was implemented in 2018 and halted in 2019.
• Where: The key states involved are Arkansas, Ohio, and Arizona. The policies have national implications for Medicaid.

The revival of Medicaid work requirements reflects a long-standing debate about the program's objectives and the role of government assistance. Proponents argue that these requirements promote self-sufficiency and reduce government spending. However, critics contend that they create unnecessary barriers to healthcare access, especially for vulnerable populations, and impose significant administrative burdens. The proposals are expected to face legal challenges, particularly Arizona's lifetime limit, with courts likely to scrutinize whether these restrictions align with Medicaid's core purpose of providing healthcare coverage to low-income individuals. The long-term impact will depend on the implementation of these policies and the outcome of legal battles.

"Most Arkansans work hard to pay for their health insurance, but many of these healthy adults don't work at all and receive it for free."

"Once this work requirement starts, we will achieve our goal of moving Arkansans off the path of government dependency and on the path to prosperity."

"It's been tested. It's a bad investment."

"When you have people losing coverage, yes, you do pay less money, but you also have extreme hardship."

"The rationale for doing that is you show how little flexibility states have under the Medicaid program and how the federal Medicaid program is so rigid that it does not allow for common-sense provisions like work requirements."

The renewed push for Medicaid work requirements and the potential implementation of lifetime limits represent a fundamental change in the program, sparking both support for fiscal and individual responsibility and significant concerns regarding coverage losses, especially for vulnerable populations like those with disabilities, women, and individuals facing homelessness. Experts estimate that millions of Americans could lose Medicaid coverage under these proposals, with potential job losses and reduced economic activity in states. The administrative complexities and reporting burdens associated with work requirements could further exacerbate coverage losses, even for those who are working or should be exempt. Moreover, the long-term implications of lifetime limits could leave many low-income individuals without affordable healthcare options, forcing them to forgo essential medical care and undermining their economic stability. The future of these policies remains uncertain, contingent on federal approval, which may shift under different administrations, the details of state implementation, and the outcomes of expected legal challenges. Furthermore, some states are exploring alternative approaches to work requirements, such as data matching and "success coaching" programs, which raise concerns about creating new bureaucratic hurdles and potential coverage suspensions. The convergence of these factors suggests a potentially destabilizing period for Medicaid, with the ultimate impact hinging on the ability of states to balance fiscal objectives with the healthcare needs of millions of low-income Americans.