36 Million People at Risk of Having Health Coverage Taken Away by Medicaid Work Requirements

Recent proposals from Republican congressional leaders and conservative think tanks would cut Medicaid by taking coverage away from people who don’t meet unnecessary and burdensome work requirements. We provide congressional district level estimates of the number of people who could be at risk of losing their coverage under Medicaid work requirements, building on estimates we published at the state level.  

We identify the population at risk of losing coverage as those who may be required to show proof of employment or of exemptions. While not everyone in this group would lose coverage, experiences with work requirements suggest that many would. Past evidence shows that work requirements impose administrative barriers and red tape that lead to coverage losses among both people who are working and people the policies purport to exempt.  

Instead of assessing a specific proposal, we provide estimates for a broad group of enrollees who may be subject to work reporting requirements. This includes adults aged 19 to 64 enrolled through the Medicaid expansion (i.e., expansion adults) and adults enrolled through other non-disability pathways (i.e., other adults).  

We estimate expansion and other adult enrollment in June 2024 using state level administrative data from June 2024 and fiscal year 2022 (see our paper for more details on methodology). We then allocate state level enrollment to congressional districts for the 119^th Congress using age-specific Medicaid enrollment estimates from the 2023 American Community Survey, following the methodology for our Medicaid and CHIP enrollment estimates by congressional district. Note that in general, enrollment is likely to be lower today than it is in the June 2024 data, as the unwinding of the Medicaid continuous coverage provision was still being implemented by states as of June 2024.