There isn\u2019t a ton of research into the effectiveness of making people prove they have jobs in order to access social services. But what evidence there is points in one direction: Placing work requirements on programs like Medicaid does almost nothing to increase employment or hours worked, while actively hurting people in need.<\/p>\n
With roughly 15 million Californians relying on Medi-Cal, the state\u2019s version of Medicaid, for their health coverage, the Golden State is staring that grim truth in the face.<\/p>\n
A significant part of Congress\u2019 so-called Big Beautiful Bill\u2019s takedown of Medicaid funding<\/a> revolves around forcing people to show that they\u2019re working 80 hours each month<\/a> before they can receive benefits. And with about a year left until that requirement takes effect, California policymakers are scrambling to mitigate its most toxic effects \u2014 even if they are legally required to implement the broader law.<\/p>\n \u201cAt the end of the day, there\u2019s not a full workaround,\u201d said Hannah Orbach-Mandel, a policy analyst at the nonpartisan California Budget & Policy Center. \u201cBut I do believe there are some ways that California can try to be a little creative about how the law is implemented, and people are looking into that now.\u201d<\/p>\n Those possibilities include using California\u2019s relatively high minimum wage ($16.90 an hour in 2026) to propose substituting income earned for hours worked under the new Medicaid rules, along with ways to streamline what is likely to be a nightmarish bureaucratic task of recording and verifying the information the federal government is demanding.<\/p>\n The stakes are certainly high enough. According to Gov. Gavin Newsom\u2019s administration, as many as 3 million Californians<\/a> could be thrown off Medi-Cal based on the work requirement alone \u2014 a significant portion of the many millions of Americans across the country who face a similar fate. While the actual numbers will rise or fall depending upon how the requirements are implemented, the resulting strain on California\u2019s health care system from fewer patients and more unreimbursed care could buckle it.<\/p>\n The work requirement derives\u00a0from a generations-old Republican talking point that most people on public assistance could be working, but are either too lazy or unmotivated to do so. Research has disproven that theory repeatedly.<\/p>\n As of 2023, nearly two-thirds of all adults aged 19-64 on Medicaid were working<\/a> full-time or part-time, according to the health policy research site KFF, formerly the Kaiser Family Foundation. Among the remainder who weren\u2019t working, the vast majority fell into one of three categories: sick or disabled, caregiving for another person or attending school. All of those groups receive exemptions<\/a> to the work requirement in the new law.<\/p>\n It\u2019s no surprise, then, that the Congressional Budget Office has already said implementing work requirements for Medicaid recipients won\u2019t move the needle<\/a> on employment. During debate on a 2023 Medicaid bill, the CBO concluded that \u201cthe employment status of, and hours worked by, Medicaid recipients would be unchanged\u201d by work requirements.<\/p>\n A couple of states have tried such restrictions<\/a> themselves, with disastrous consequences. In the first seven months after Arkansas implemented work requirements in 2018, for example, roughly 18,000 people lost their Medicaid<\/a> coverage \u2014 most of them, state officials said, not because they didn\u2019t qualify, but because they either didn\u2019t understand the new rules or couldn\u2019t navigate the maze of administrative details and gave up, losing their health care access in the process.<\/p>\n Meanwhile, there was no notable improvement to the state\u2019s employment numbers or to its total number of hours worked, a finding that has been confirmed by more recent research<\/a>. The Arkansas requirements were halted in 2019 by a federal judge who ruled the program did not meet the objectives<\/a> of the Medicaid program.<\/p>\n Nevertheless, Republicans enshrined such requirements nationally in H.R. 1<\/a> this year, and they are set to go into effect Jan. 1, 2027. They also further mandated that Medicaid recipients repeat the qualification process twice each year. The budget reconciliation bill says that those in the Medicaid expansion group between the age of 19 and 64 must show that they\u2019re either working, going to school, in job training or doing community service at least 80 hours a month in order to stay eligible.<\/p>\n Those rules will chase people off Medicaid, which could increase death rates<\/a> and lead to severe financial trouble. Many of those people, Orbach-Mandel says, will still fully qualify to receive benefits, but they either won\u2019t know it or will get lost in red tape.<\/p>\n In California, 3 million people suddenly losing their health coverage means they\u2019ll likely have no health insurance and no access to regular care, and will instead wait to see a doctor until they need to go to the emergency room \u2014 the one place where they know they cannot be denied care even if they can\u2019t pay.<\/p>\n It all adds up to a massive new strain on an already overburdened health care system.<\/p>\n \u201cThat burden ends up falling on a lot of hospitals, like safety-net facilities,\u201d Orbach-Mandel said. Many of those hospitals are already struggling to survive<\/a> financially. The combination of fewer Medi-Cal patients and higher unreimbursed emergency room costs could drive them to discontinue certain services or face possible closure, as hospitals in Willows<\/a> and Inyo County<\/a> recently have discussed.<\/p>\n The Medicaid takedown is\u00a0an almost perfectly Trumpian gambit: It helps to finance massive tax cuts for the nation\u2019s richest individuals at the expense of some of the most vulnerable Americans, many of whom voted for Donald Trump<\/a>. Republicans championed the work requirements mostly as a way to kick people off Medicaid.<\/p>\n