Work Requirements for Medicaid Eligibility? Conflicting core values need to be reconciled.

Work Requirements for Medicaid Eligibility?

Rick Olson
July 22, 2025

This topic brings two of my core values into tension:

·        The American ideal of individual responsibility—caring for oneself and one's family

·        A deep compassion for those in need, especially when it comes to healthcare.

Medicaid work requirements are rules that some states have tried to implement requiring certain Medicaid recipients to work, volunteer, or participate in job training in order to maintain their Medicaid health coverage.

The One Big Beautiful Bill Act of 2025 contained the following, according to Chatgpt.com:

“Engagement Requirements

·         Adults aged 19–64 (not otherwise exempt) must perform 80 hours per month of qualifying activities, which include:

o    Paid employment,

o    Volunteering or community service,

o    Enrollment in job training or educational programs,

o    Earning the equivalent of minimum-wage pay for 80 hours/month

·         States must verify compliance at two key points:

o    At application, using a look-back over one to three prior months,

o    At least semi-annually, during eligibility redeterminations

·         If non-compliance is detected, the applicant or enrollee gets a 30-day notice period to resolve it. Failure to comply can lead to denial or termination of eligibility

Exemptions

Certain groups are automatically exempt from the 80-hour requirement:

1.     Pregnant or postpartum women

2.     Parents/caregivers of a child aged 13 or younger, or caring for someone with a disability

3.     People designated “medically frail”, which includes:

o    Disabilities (physical, intellectual, developmental),

o    Serious medical conditions,

o    Substance use disorders,

o    Mental health disorders

4.     Disabled veterans

5.     Members of federally recognized tribes or eligible for Indian Health Services

6.     Individuals receiving SSI or considered disabled, including “medically frail”

7.     Adults under 19 or over 64

8.     People who are recently incarcerated or in counties with disasters or high unemployment, and those in rehab/substance-use treatment programs

·         States may also provide optional waivers for temporary hardship (e.g., disease, hospitalization, natural disaster, transportation issues)

Timeline

·         Compliance begins: Generally December 2026 or January 2027, depending on state implementation

·         Semi‑annual reviews and other verifications also kick in during this period”

My reactions:

1.     If this part of OBBBA had been the only subject of the bill, I would have likely supported the bill. To be compassionate for those who need help, it will now be necessary for the MN legislature to ensure that qualifying people do not fall through the cracks. We will need to make sure those eligible via an exemption can meet the requirements with a well-publicized and easily accessible system of proving their eligibility.

a.      I say "likely", as I would need to do further research on some of the definitions, such as “disability”. The “medically frail” exemption is important as some medical conditions are sufficiently disabling to make work difficult or even impossible for some jobs. However, one’s remaining abilities may be sufficient for other types of jobs, so more thought may be needed on this issue. I believe people’s abilities are enormous so we should put more focus on remaining abilities and not treat people with some “disabilities” as total useless. There may need to be some subjectivity involved in this exemption, so that presents a potential problem for consistency in treating claimants.

b.     The exemptions appear reasonable and should cover most problem cases. Additional thought may be needed regarding full-time caregivers for people not included in the law, as frequently it falls on a family member to be the caregiver, which makes working nearly impossible. Even part-time caregivers may create eligibility issues, depending on the timing and nature of the care required.

a.      The Engagement Requirements appear reasonable, if the states’ infrastructure and enrollment communication is robust enough, which is critical to avoid the problems in other states’ previous attempts, where many lost eligibility because either they were not aware of what they needed to do or got lost in the paperwork.

For people without disabilities, most should not find the requirements hard to fulfill. For people in remote areas without good Internet access, they may be a bit more difficult, however, so that may need to be addressed. We will need to ensure that ample opportunities that are easily accessed and well publicized exist for further online job training and educational opportunities and/or community service opportunities.

b.     The effective date is far enough away that the states should have the opportunity to create and implement effective infrastructure and enrollment communication systems.

c.      We will need to solicit public comment regarding potential problems so we can proactively address the problems. The states have the ability to request waivers to deal with issues that may arise, such as lack of job opportunities in an area, lack of transportation options for the claimant, etc. to remedy oversights in the federal provisions to protect people who may fall through the cracks that become apparent upon implementation. In so doing, we will need to keep in mind the state’s dilemma of needing to balance the budget despite the yawning $2 billion budget gap for the coming two fiscal bienniums.

d.     We need to continue to favor self-reliance where reasonable instead of a total reliance on government to take care of us.

e.      According to the Congressional Budget Office’s assessment (reported by KFF), the Medicaid work requirement provisions in the OBBBA would save approximately $344 billion in federal spending over the next 10 years (2025–2034). We need to make reasonable cuts to our federal spending while being reasonably compassionate towards those in need. I perceive an adequate balance would be struck with this treatment of work requirements for Medicaid eligibility if enacted in isolation.

2.     I would have voted “no” regarding OBBBA as a whole.

a.      Extending the tax provisions which disproportionately favor the wealthy cannot be justified given the current and projected additional debt and current income distribution in the U.S. 44% of the tax breaks go to the richest 5% and 69% to the richest 20% according to Chatgpt.com:

b.     In response to a prompt, Chatgpt.com also responded:

“under the Senate’s 2025 proposal under the OBBOA:

Our national debt is approximately $36.216 trillion, as of June 28, 2025, which is about 124% of our GDP, comparable to the peak levels during and after World War II. According to the CBO and related analyses, extending the 2017 Trump-era tax cuts—most of which benefit higher-income individuals—would significantly increase the national debt over the 2025–2034 period to around $4.5 trillion, consisting of roughly $3.9 trillion of reduced federal revenue and the higher debt service and higher interest rates driven by higher borrowing.”

 Both the current level and the projected increase alarm most economists. It is a ticking time bomb that will drastically harm the economy that our kids and grandkids will inherit.

As a former lifelong Republican (including being a Republican State Representative in Michigan in 2011-12), I believed in fiscal responsibility. Now, as a DFL candidate for MN State Senate, I still hold that belief. We need to make hard decisions based on the facts and not on partisan positions.

Prepared and paid for by Olson Senate Committee, P.O. Box 15, Prior Lake, MN 55372.