President Donald Trump’s administration announced this week that states would be allowed to impose work requirements as a condition of receiving Medicaid health coverage. Gov. John Bel Edwards said his administration is “actively working” on a proposal to connect adult Medicaid recipients with work or job-training opportunities. While the idea of a work requirement may sound good to some, the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment.

Here are some facts policymakers should consider:

1. The vast majority (76 percent) of Louisiana’s Medicaid expansion enrollees are already working, caring for family members, or in school.

  • 7 in 10 enrollees live in a household with at least one worker.
  • More than half (52 percent) of enrollees are themselves working.
  • 13 percent of Medicaid enrollees are not working but are caring for a family member.
  • 11 percent of enrollees are not working but are attending school.

2. A Medicaid work requirement could threaten coverage for some people with disabilities.

  • Of those not working, nearly 3 in 10 (29 percent) Louisiana Medicaid expansion enrollees report being in poor health or having a physical or mental disability.
  • Many enrollees have physical or mental health disabilities that interfere with their ability to work but are not serious enough to qualify for Supplemental Security Income (SSI).
  • Nearly 9 in 10 (88 percent) of Medicaid adults who report not working due to illness or disability has a functional limitation, including limitations caused by cancer, stroke, heart disease, arthritis, or asthma

3. Taking away Medicaid won’t help anyone find or keep a job.

  • Losing coverage — and, with it, access to mental health treatment, medication to manage chronic conditions, or other important care — could make it harder for people to find work.
  • A Medicaid work requirement could prevent people with substance use disorders such as opioid addiction from getting care – care that could allow some people to improve their health and join in the workforce.
  • Louisiana’s Medicaid expansion has given 48,000 Louisianans access to mental health services and allowed 15,000 working-age adults to newly access treatment for substance abuse disorders.

4. Medicaid already supports work.

  • In studies of adults who gained coverage in Ohio and Michigan under Medicaid expansion, majorities said that gaining health coverage has helped them look for work or remain employed.
  • Three-quarters of beneficiaries in Ohio who received coverage through Medicaid expansion and who were looking for work reported that Medicaid made it easier to do so.

5. Work requirements could create a costly administrative burden for the state that could jeopardize coverage for those who are working or who may be exempt from work requirements.

  • A 2017 bill seeking a Medicaid work requirement in Louisiana would have cost the state an estimated $4 million just for technological changes in the Medicaid eligibility system.
  • Additional full-time state employees would also be required to periodically verify and monitor enrollees’ work status.
  • If people face administrative obstacles to verifying their work status or documenting an exemption, they would be at risk of unnecessarily losing coverage.

6. A work requirement in Medicaid would drive up costs of health care for the state, providers, and all health care consumers.

  • Those who lose Medicaid coverage because they don’t meet the work requirements will lose access to preventive care, and will still require medical care when they get sick.
  • The cost of treating the uninsured will fall on local hospitals, the state, and other health care providers, and will ultimately be passed on to health care consumers through higher premiums and out-of-pocket costs.


Kaiser Family Foundation state-level analysis of March 2017 Current Population Survey.

Rachel Garfield, Robin Rudowitz, and Anthony Damico, Understanding the Intersection of Medicaid and Work. Kaiser Family Foundation. Revised January 2018.

Hannah Katch, Medicaid Work Requirement Would Harm Unemployed, Not Promote Work. Center on Budget and Policy Priorities. January 11, 2018.