Michigan's Medicaid Work Requirement System: Lessons and Warnings for Other States

In March 2020, Robert Gordon faced a challenging moment as he prepared to implement Michigan's Medicaid work requirement, which threatened to cut health coverage for up to 100,000 residents. As the state's health director, Gordon had invested approximately $30 million in building a system designed to monitor compliance and prevent unnecessary disenrollments. Despite efforts to accommodate exemptions and automate reporting through cross-referencing data from other programs, the massive scale of the initiative posed significant logistical hurdles.

Initially, most Medicaid recipients in Michigan were already meeting the work requirements through employment, volunteering, or exemptions, but a large segment—estimated between 80,000 and 100,000 people—still needed to report their activities. Before the law could be fully enforced, a federal judge blocked Michigan's policies on March 4, 2020, halting the process and rendering much of the state's investment ineffective. This swift legal action prevented the loss of coverage for many residents at a critical time, as the COVID-19 pandemic was beginning to spread across the nation.

Gordon emphasized that Michigan was comparatively better prepared than other states due to its low unemployment rate and its existing data collection systems. The state adapted its law to facilitate more lenient reporting periods and used cross-checking with other assistance programs to automatically determine compliance or exemptions. Nonetheless, the implementation required extensive resources, including reprogramming outdated systems, establishing call centers, and training staff—all of which diverted attention from other urgent public health issues.

Despite the hefty investment and meticulous planning, Gordon and his team recognized their system was far from perfect. They predicted that systemic flaws might cause many eligible individuals to fall through the cracks, unintentionally losing coverage. Conversely, the brief implementation period led to skepticism among critics who argued that the subsequent legal ruling demonstrated the law's impracticality and wastefulness.

Looking ahead, the reintroduction of federal mandates for Medicaid work requirements raises concerns about potential nationwide coverage losses, especially in states poised to implement these policies. Gordon warns that such requirements may prove more administratively burdensome than beneficial, risking increased uninsured populations just as the COVID-19 crisis underscored the importance of accessible healthcare.

Ultimately, Michigan’s experience illustrates how challenging and expensive implementing Medicaid work requirements can be and underscores the importance of thoroughly evaluating their real-world impact before widespread adoption. The case also highlights the crucial role of legal and policy considerations in shaping Medicaid reforms.

Source: https://medicalxpress.com/news/2025-09-built-michigan-medicaid-requirement-states.html