Urgent Preparations Needed as Medicaid Work Requirements Loom

With just over a year remaining before the implementation deadline, states with Medicaid expansion in 40 states must begin verifying beneficiaries' compliance with work requirements, or establish exemptions for medical or caregiving reasons. According to a health care researcher at the University of Michigan, there is no time to delay in preparing for this shift. In a Perspective article published in the New England Journal of Medicine, Dr. John Z. Ayanian emphasizes the importance of coordinated efforts among states, health care providers, community groups, and researchers to safeguard Medicaid coverage for eligible individuals.

Ayanian, who leads the U-M Institute for Healthcare Policy and Innovation, highlights the necessity for state agencies to develop automated systems that can reliably verify work or exemption status through payroll, tax, and Medicaid records. Clear, multi-channel communication strategies are crucial to inform beneficiaries about their responsibilities and the steps needed to maintain coverage.

Further, health care providers require guidance on assessing whether a patient's health condition warrants exemption from work requirements. This is especially pertinent for patients with serious health issues who may be unable to work or participate in community engagement activities.

The article stresses the critical need for health organizations to support patients with significant medical needs to understand and navigate these new rules. Equally, researchers face the challenge of evaluating the effects of work requirements on Medicaid enrollees, despite restrictions on conducting gold-standard randomized studies.

Ayanian provides key facts about Medicaid enrollee demographics, noting that even without work mandates, a substantial proportion of recipients are already engaged in work, caregiving, education, or are unable to work due to health reasons. To qualify for Medicaid in the expanded states, enrollment is limited to those earning up to approximately $21,600 annually for individuals, or 138% of the federal poverty level.

This initiative, part of the One Big Beautiful Bill Act signed into law in July 2025, aims to promote employment while ensuring coverage for vulnerable populations. As states gear up for these changes, proactive measures by all stakeholders are essential to prevent unnecessary loss of health coverage and to uphold the health and well-being of Medicaid beneficiaries.

Source: Medical Xpress