Changes to Medicaid Eligibility in H.R.1

• Authors: Heather Howard (Princeton University), Joshua Varcie MPA ’25 (Princeton University), Shamik Bhat MPA ’25 (Princeton University/Yale University), and Teddy Knox MPA ’25 (Princeton University)
• Title: Over 3 in 4 adults potentially subject to Medicaid work requirements may already have a route to exclusion or compliance 
• Journal: Health Affairs Scholar

On July 4, 2025, President Donald Trump signed H.R. 1, which implemented a new requirement for certain adult Medicaid enrollees between the ages of 19-64 to work, attend school, or participate in other community engagement activities for at least 80 hours per month to qualify for health insurance coverage. 

“Starting January 1, 2027, enrollees will have to demonstrate they are complying with or excluded from the requirements,” said Heather Howard, professor of the practice, co-director of the Global Health Program, and faculty affiliate of the Center for Health & Wellbeing. “In many cases, states will be able to use existing data to automatically verify compliance or exclusion from the requirements, but for more complex cases where data is not available, individuals may have to submit documentation to the state, which adds burdens for enrollees and may cause some who are eligible for Medicaid to lose coverage because they do not submit the necessary paperwork.”

Using publicly available data from the census, the team found that 78 percent of people on Medicaid likely have a way to meet the new work requirements.

“Specifically, we find that about 46 percent of people will not have to satisfy the requirements because they qualify for one of the law’s ‘exclusions,’” said Howard, which include being a parent of a child under 13 or a caretaker of a disabled individual, having a medical condition that significantly impairs an individual’s ability to work, or being an American Indian or Alaska native, among other demographic options. “We also find that 58 percent of people will be in compliance with the work requirements because they are working or attending school. Many people who meet the requirements will also qualify for one of the law’s exclusions.”

The team acknowledges that while most people will meet the new requirements, many are still at risk of losing Medicaid coverage if they fail to submit the right documents to their state Medicaid agency.

“States need to make significant changes to their Medicaid processes in a short time frame to minimize the amount of documentation people need to submit,” Howard said. “Our findings suggest that the number of people who lose coverage under the new law depends crucially on how well states execute these changes.”

“H.R. 1 made sweeping changes to healthcare, none more consequential than the imposition of Medicaid work requirements,” Howard said. “It fundamentally alters the entitlement nature of the program, and, through new paperwork burdens, will result in millions of Americans losing their health coverage. But our research shows that, with effective implementation, many people should be able to meet the new requirements and keep their coverage. Our research can help states target their efforts more effectively.”