What Is the Impact of Work Requirements?

The House passed a bill last Wednesday that would lift the debt ceiling and cut trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to persuade the White House to start talks before a fast-approaching deadline to prevent a default.

The Limit, Save, Grow Act of 2023 was passed by the House by a vote of 217 to 215, with all but four Republican members voting in favor. Representatives Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee, and Matt Gaetz of Florida voted against the bill. All Democrats opposed its passage.

With this bill, the debt ceiling would be raised by $1.5 trillion or until the end of March 2024, whichever comes first. The bill would decrease spending by $4.5 trillion. Biden has promised to veto it. McCarthy hopes the vote will allow him to persuade the president to start discussions. However, the bill was an early test of McCarthy’s capacity to unify a discordant Republican caucus.

According to the bill, childless, non-disabled adults ages 18 to 55 might get food stamps for only three months out of every three years unless they work at least 20 hours per week or meet other criteria. Those between 18 and 49 are currently subject to the requirement, which has been waived during the Covid-19 public health emergency, which ends next month.

Estimates of the number of people affected vary. According to a Congressional Budget Office report released Monday, 275,000 people would lose benefits each month if they did not meet the condition and were not otherwise exempt. Another 19,000 people would gain minor benefits due to their new income.

Others anticipate a much greater impact. According to the Center on Budget and Policy Priorities, the provision would put about 900,000 people between the ages of 50 and 55 at risk of losing their food assistance unless they work enough hours and report that employment to their state agencies, receive an exemption, or reside in an area where the mandate is waived.

Per the debt ceiling proposal, some adult Medicaid participants must work, volunteer, or be enrolled in a program for at least 80 hours per month or meet a minimum income requirement. It would apply to those aged 19 to 55. However, it would not apply to pregnant women, parents with dependent children, or those unable to work due to physical or mental health disabilities.

Enrolling in education or substance abuse programs would mean someone would be exempt. This primarily targets low-income individuals eligible for Medicaid expansion, a feature of the Affordable Care Act.

The Centers for Medicare and Medicaid Services (CMS) announced guidelines in January 2018. They allow states to use 1115 Waivers to implement “work and community engagement” requirements for Medicaid beneficiaries.

Adult Medicaid beneficiaries who are 65 or older, pregnant, or qualify for Medicaid because they receive disability benefits under the Supplemental Security Income (SSI) program are exempt from employment rules, according to the Centers for Medicare and Medicaid Services. However, approximately three-fifths of all non-elderly adult Medicaid members with disabilities, or nearly five million people, do not receive SSI. As a result, job requirements will continue to have substantial – and presumably disproportionate – effects on people with disabilities.

For example, according to the Arkansas Department of Human Services, there were 265,223 Arkansas Works enrollees, with more than 62,000 affected by the newly implemented employment requirements. By December 2018, more than 18,000 people had lost Medicaid coverage because they did not meet the eligibility requirements.

Medicaid has never had a work requirement, but the Trump Administration granted waivers to several states to impose one for some participants. Litigation prevented or slowed state participation in the effort. Subsequently, the Biden administration later revoked the waivers.

Medicaid and SNAP benefits are vital programs for millions of Americans. Medicaid provides essential services to millions of people in this country, including home and community-based services, medications, and immunizations. SNAP benefits allow people access to nutritious foods to help feed themselves and their families. Work requirements will mean many people will lose these benefits, which could be catastrophic.


Bailey, Anna, and Judith Solomon. “Medicaid Work Requirements Don’t Protect People with Disabilities.” Center on Budget and Policy Priorities, Center on Budget and Policy Priorities, 14 Nov. 2018, https://www.cbpp.org/research/health/medicaid-work-requirements-dont-protect-people-with-disabilities.

Froelich, Jacqueline. “In Arkansas, Thousands of People Have Lost Medicaid Coverage over New Work Rule.” NPR, NPR, 18 Feb. 2019, https://www.npr.org/sections/health-shots/2019/02/18/694504586/in-arkansas-thousands-of-people-have-lost-medicaid-coverage-over-new-work-rule.

Kaye, Steve. How Do Disability and Poor Health Impact Proposed Medicaid Work Requirements? Brandeis University, Feb. 2018, https://doi.org10.48617/rpt.347.

Luhby, Tami. “Republicans Use Debt Ceiling Bill to Push Work Requirements for Millions Receiving Medicaid and Food Stamps .” CNN, Warner Bros. Discovery, 26 Apr. 2023, https://www.cnn.com/2023/04/26/politics/work-requirements-food-stamps-medicaid-debt-ceiling/index.html.

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