Understanding Medicaid Work Requirements in the “Big Beautiful Bill”

A new KFF policy explainer walks through the Medicaid work requirements proposed in the “One Big Beautiful Bill Act” that the House passed in May (and that the Senate Finance committee proposed substantive changes to in June), including who would be affected by the new requirements and how and when states would be required to implement them. The proposed work requirements are more stringent than previous policies considered by Congress and implemented at the state level. 

The Congressional Budget Office (CBO) estimates work requirements would be the largest source of Medicaid savings of all the provisions included in the House bill, reducing federal spending by $344 billion over 10 years and increasing the number of uninsured by 4.8 million. State flexibility to impose more stringent requirements than the minimum requirements outlined in the bill, and state capacity to use existing data (e.g., payroll) to automatically verify compliance with the requirements (without requiring individuals to “self-report”), may impact the number of people at risk of losing coverage.

In a related brief, KFF examines how Medicaid work requirements may pose challenges for adults with mental health or substance use disorders, including additional barriers they may face documenting compliance with work requirements or proving eligibility for an exemption.Read the brief