Study Finds Medicaid Work Requirements Do Not Improve Insurance Coverage or Employment Rates

Recent research published in The BMJ reveals that introducing work requirements for certain low-income adults enrolled in Medicaid has not led to increased health insurance coverage or higher employment rates. The study focused on Georgia, the first state to implement Medicaid expansion under the Pathways to Coverage program in 2023, which included work requirements. Researchers analyzed data from 17,451 working-age adults between 2021 and 2024, comparing Georgia with five neighboring states—Alabama, Florida, Mississippi, South Carolina, and Tennessee—that did not adopt similar measures.

The findings showed that 15 months after implementation, Medicaid coverage in Georgia slightly decreased from 35.5% to 32.4%, whereas neighboring states' coverage remained relatively stable. There was no significant change in employment rates among low-income adults in Georgia compared to control states. An additional analysis suggested that Medicaid coverage actually declined by nearly 12 percentage points in Georgia relative to South Dakota, which expanded Medicaid without work mandates, with no observed employment changes.

The authors explained that many Medicaid beneficiaries either already work or are unable to work, and complex enrollment procedures may hinder coverage gains. They acknowledged limitations such as reliance on self-reported data, low survey response rates, and the short duration of observation, indicating that further research is necessary to assess long-term effects.

Ultimately, the study concludes that the Pathways to Coverage program did not improve insurance coverage or reduce the uninsured rate during its initial year, raising questions about the effectiveness of work requirements as a policy tool. These results are particularly relevant as US policymakers plan to extend Medicaid work mandates nationwide starting in 2026.