To amend title XIX of the Social Security Act to implement a minimum work requirement for able-bodied adults enrolled in State Medicaid programs.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill adds a work requirement to Medicaid, requiring able-bodied adults to work or volunteer at least 20 hours per week to keep their health coverage. The requirement would take effect on January 1, 2026, and applies to adults aged 18-65 who do not qualify for specific exemptions. It changes the Social Security Act to make states deny Medicaid coverage to people who fail to meet this work requirement.
Who Benefits and How
State governments benefit by potentially reducing their Medicaid expenditures as fewer people qualify for coverage. Employers in low-wage sectors like retail, food service, and hospitality may benefit from increased availability of workers, as people need to work or volunteer 20 hours per week to maintain health coverage. Conservative policy advocates promoting work requirements for welfare programs gain a legislative victory advancing their policy goals.
Who Bears the Burden and How
Low-income adults aged 18-65 without young children or disabilities face the burden of losing health coverage if they cannot meet the 20-hour weekly work or volunteer requirement. This particularly affects people in unstable employment situations, those with barriers to work not recognized as disabilities, and those living in areas with limited job opportunities. State Medicaid agencies must build new systems to verify work hours and compliance, creating administrative costs and staffing burdens. Healthcare providers and hospitals serving low-income populations face reduced patient volume and revenue as people lose coverage. Taxpayers may see increased costs if uninsured people use expensive emergency room care instead of preventive care.
Key Provisions
- Requires able-bodied Medicaid recipients to work or volunteer 20 hours per week (monthly average) starting January 1, 2026
- Exempts people under 18 or over 65 years old from the work requirement
- Exempts pregnant women, parents caring for children under 6, and caretakers of disabled dependents
- Exempts people medically certified as physically or mentally unfit for employment
- Exempts people receiving unemployment benefits and complying with unemployment work requirements
- Exempts people participating in drug addiction or alcohol treatment programs
- Gives state agencies authority to determine medical conditions and disabilities that qualify for exemptions
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires able-bodied adults to work or volunteer 20 hours per week to qualify for Medicaid coverage, effective January 1, 2026.
Who Benefits
- State governments seeking to reduce Medicaid expenditures
- Conservative policy advocates promoting work requirements
- Employers potentially gaining low-wage workers
Who Bears Costs
- Low-income able-bodied adults aged 18-65 without dependents or disabilities
- State Medicaid agencies (implementation and verification burden)
- Healthcare providers serving low-income populations (reduced patient base)
Key Policy Areas
Healthcare, Social Welfare, Labor
Primary Purpose
Requires able-bodied adults to work or volunteer 20 hours per week to qualify for Medicaid coverage, effective January 1, 2026.
Policy Domains
Legislative Strategy
"Reduce Medicaid enrollment and costs by imposing work requirements on non-exempt adults, aligning with SNAP and TANF welfare reform approaches"
Identified Gains
- State governments seeking to reduce Medicaid expenditures
- Conservative policy advocates promoting work requirements
- Employers potentially gaining low-wage workers
Identified Costs
- Low-income able-bodied adults aged 18-65 without dependents or disabilities
- State Medicaid agencies (implementation and verification burden)
- Healthcare providers serving low-income populations (reduced patient base)
Sponsors
Legislative Progress
IntroducedMr. Crenshaw introduced the following bill; which was referred to …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Individuals in addiction treatment programs (exempted), Low-income able-bodied adults aged 18-65 without dependents or disabilities seeking Medicaid coverage, Parents/caretakers of children under 6 or disabled children (exempted)
Positive-direction: Individuals in addiction treatment programs (exempted), Parents/caretakers of children under 6 or disabled children (exempted), Pregnant women (exempted from work requirement)
Negative-direction: Low-income able-bodied adults aged 18-65 without dependents or disabilities seeking Medicaid coverage
State Medicaid agencies administering work requirement verification
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "state_agency"
- → State agency established or designated to administer or supervise the administration of the State plan
Key Definitions
Terms defined in this bill
An able-bodied adult must either work 20 hours or more per week (monthly average) or volunteer 20 hours or more per week (monthly average).
Any individual who is not: under 18 or over 65; medically certified as physically or mentally unfit for employment; pregnant; primary parent or caretaker of dependent child under 6; primary parent or caretaker of dependent child with serious medical condition or disability; receiving unemployment compensation; or participating in drug addiction or alcoholic treatment and rehabilitation program.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology