Medicaid Work Rules to Strip Coverage from Millions Starting 2027

WASHINGTON — Approximately 18.5 million adults ages 19 to 64 in 42 states and Washington, D.C., face new Medicaid work requirements set to launch January 1, 2027, under the One Big Beautiful Bill Act, signed by President Trump on July 4, 2025.[1][2][3] The nonpartisan Congressional Budget Office projects that 5.2 million people will lose coverage due to these rules, with total Medicaid enrollment dropping by up to 11.8 million over the next decade, including 4.8 million directly from work mandates.[3][5] The law targets Medicaid expansion populations—adults with incomes up to 138% of the federal poverty level—requiring proof of at least 80 hours per month in qualifying activities like paid work, volunteering, job training, or half-time school enrollment.[2][4] To retain eligibility, enrollees must report compliance at least every six months, though some states may demand more frequent updates.[1][2] Exemptions apply to those 65 or older, people with disabilities, pregnant women, parents of minor children, and individuals with serious health issues.[1][3] In Indiana, the rules will affect about 33% of the state's Medicaid population.[1] Georgia, the only state with prior work requirements since 2023 under a partial expansion, serves as an early test case.[4] Republican lawmakers in several states argue the federal minimum falls short, with proposals to triple the required work period to promote self-sufficiency.[1] The Congressional Budget Office estimates the changes will slash Medicaid spending by $344 billion over 10 years, fulfilling a key GOP budget goal in the 2025 reconciliation bill, H.R. 1.[5][8] States can seek federal approval for earlier implementation or, with Health and Human Services Department permission, delay until December 31, 2028, if showing good faith efforts.[3] Health policy experts question the mandates' effectiveness. A 2023 CBO study and KFF analysis found most Medicaid adults already work or qualify for exemptions, with requirements likely causing coverage losses through reporting failures rather than boosting employment.[3][4] As of December 2025, Medicaid and CHIP cover nearly 76 million Americans, including 20 million expansion adults, many in low-wage jobs.[4][6] Advocacy groups warn of administrative burdens on states and providers, potentially straining healthcare access for vulnerable populations.[5][6]