Medicaid Work Requirement: The Latest Developments

On Monday evening, a news show played a clip of House Speaker Mike Johnson (R-LA) answering press questions about the progress of the “big, beautiful bill” that is pending in the House of Representatives. With a big smile, he made a point of predicting that the Medicaid “work rule” would likely sail through the reconciliation process because “it’s a no-brainer.”

Indeed, it IS a no-brainer, but not in the way that Speaker Johnson meant.

He might want to place a call to former House Speaker Paul Ryan (R-WI) whose job it was in 2017 to help the first Trump administration and the new president’s Congressional allies in their crusade to pound the recent Affordable Care Act and the Medicaid-expansion rules into the ground.

That effort included encouraging states to submit “waiver” applications for approval of new “work or community service” eligibility requirements for “able-bodied” adult Medicaid applicants. These waivers were approved but the experiment failed rather spectacularly. See, for example:

• Understanding the Intersection of Medicaid and Work: An Update (February 4, 2025) Jennifer Tolbert et al, kff.org
• Work Requirements for Medicaid Enrollees (April 2, 2024, updated January 14, 2025) Explainer, Akeiisa Coleman & Sara Federman, The Commonwealth Fund
• Medicaid 101 ( May 28, 2024), Robin Rudowitz et al, kff.org
• An Overview of Medicaid Work Requirements: What Happened Under the Trump and Biden Administrations? [Issue Brief] (May 3, 2022) Madeline Guth & Mary Beth Musumeci, kff.org
• Did Medicaid Work Requirements Achieve Their Goals in Arkansas? (September 15, 2020) Nia Johnson et al, Commonwealth Fund Blog
• Why the Court Once Again Struck Down Federal Approval of Medicaid Work (March 29, 2019) Prof. Sara Rosenbaum, Commonwealth Fund Blog 
• Work Requirements May Be Just the Beginning of Medicaid Changes Under Trump (January 11, 2018) Mattie Quinn, governing.com
• Myths About The Medicaid Expansion And The ‘Able-Bodied’ (March 6, 2017) Leighton Ky & Erin Brantley, healthaffairs.org

Mandatory Volunteerism Issue

As the GOP House caucus continues its budget-reconciliation deliberations this evening, it’s unclear which provisions regarding the Medicaid program will be kept in the proposed measure and whether it will be approved down the road by Congress.

In any event, it’s important to keep in mind the long-standing position – that is, opposition – of the charitable community on the issue of cuts in Medicaid generally as well as on imposition of “mandatory volunteerism” requirements in particular.

The National Council of Nonprofits has a dedicated page on its website explaining the myriad problems associated with government unilaterally imposing such a requirement that unduly burdens the nonprofit sector. See Mandatory Volunteerism. “Mandatory volunteerism is a mandate on an individual to volunteer, sometimes called ‘community engagement’ or ‘community service,’  with a nonprofit for a specific number of hours per week in order to be eligible for certain government-provided benefits.”

While NCN “supports programs that promote volunteering activities that mutually benefit individuals and the people served through nonprofits,” it “opposes proposals to condition receipt of government-provided benefits on requirements that individuals volunteer at nonprofit organizations, a policy known as ‘mandatory volunteerism,’ that impose increased costs, burdens, and liabilities on nonprofits by an influx of coerced individuals.”

Among the problems connected with “mandatory volunteerism” is that rarely do the bill sponsors “ever ask whether nonprofits in their communities can handle an onslaught of hundreds or thousands of individuals showing up on nonprofit doorsteps for the purpose of doing time rather than doing good.”

Taking the cue from NCN on this point, we wrote about it in several earlier posts –  from Mandatory Volunteerism: A Bad Idea All Around (March 15, 2018) FPLG Blog to Mandatory Volunteerism: Still, A Bad Idea (May 11, 2023) FPLG Blog.

Conclusion 

We’ll pick up this conversation in our next post, particularly if there are indications in the current House debate and discussions that the GOP majority is serious about not only adopting a work requirement but also moving up the start date to January 1, 2026 instead of the previously proposed January 1, 2029.

– Linda J. Rosenthal, J.D., FPLG Information & Research Director