Medicaid was meant to provide health care to the vulnerable — a pregnant mother, a disabled father, a poor child — but the most common new enrollee of the past decade has been an able-bodied adult.
While these recipients might need support for a time, the system’s design should encourage them to enter the workforce.
But about 59 percent of nondisabled adults on Medicaid did not work in 2024, according to new estimates from the Foundation for Government Accountability, a conservative think tank. For those without dependents, that number was 66 percent.
These new estimates are based on information obtained from a handful of states via public records requests. Some that didn’t respond, such as New York and California, are known for lax eligibility checks.
Almost 85 percent of new Medicaid enrollees between 2013 and 2023 were able-bodied adults, according to the foundation’s analysis of Congressional Budget Office data.
The expansion of Medicaid under the Affordable Care Act to jobless but able-bodied adults has drawn resources away from the truly needy, leaving the most vulnerable on waiting lists.
These findings come as the Trump administration finalizes its rules for implementing work requirements that were included in last year’s tax bill.
Democrats accuse the GOP of stripping coverage from people who deserve it, but the new requirements are reasonable: Able-bodied adults between ages 19 and 64 must work, volunteer, attend job trainings or go to school for at least 80 hours per month. Those working can also fulfill the requirement by earning at least $580 per month.
In many states, an entry-level wage can reach that threshold with only eight hours of work per week. There are also exemptions to protect those who have legitimate reasons not to be working: pregnant mothers, caretakers for young children or disabled family members and those attending drug treatment programs.
Another worthy exemption is for the “medically frail.” But the Trump administration’s rule, which is set to take effect next year, lets recipients self-attest to being frail rather than having to provide a doctor’s note. That creates a loophole that will be abused.
A better option would be to require proof of medical frailty from the start, as the food stamp program already does to establish whether someone is “unfit” to work.
It’s valid to worry that requiring extra paperwork to comply with new rules will lead deserving people to lose medical coverage because they struggle to comply.
States, which administer Medicaid, should address that by keeping the process as streamlined and simple as reasonably possible. The point is not to erect hoops to jump through for the sake of jumping through hoops. It’s to ensure that those receiving coverage cannot actually work.
The administration says it will start requiring documentation in 2028 to demonstrate medical frailty. At that point, self-attestation would grant a recipient only six months of eligibility in a year.
But Hayden Dublois, data and analytics director for the Foundation for Government Accountability, notes that recipients could be disenrolled after six months and then reenroll through self-attestation. “That allows them to keep gaming the system,” he said in an interview.
Some states already admitted in a recent lawsuit against the Trump administration that this ruse would work.
The work requirements are expected to save $326 billion for taxpayers over the next decade. Just as importantly, the new rules will encourage people to become more self-sufficient and experience the dignity of work. Holding a job is the first step toward becoming financially secure, starting a family and contributing to society.
That’s the life all able-bodied adults on Medicaid deserve.
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