• Posted September 2, 2026

Millions Will Lose Medicaid Because They Aren't Able To Get Enough Work Hours, Study Predicts

About 1 in every 5 eligible adults in Medicaid expansion states might lose their benefits due to new work requirements that take effect in 2027, a new study says.

These folks likely will be unable to fulfill the minimum work hours required under the new law, researchers reported Aug. 28 in JAMA Health Forum.

More than two-thirds (66%) of Medicaid recipients are working, with more than 85% working over 35 hours a week, researchers found.

However, short and inconsistent work hours offered by employers will prevent as many as 10 million working Medicaid recipients from completing the 80 hours they need each month to qualify, researchers concluded.

“These results show that the ideological narrative of Medicaid recipients just needing to pull themselves up by their bootstraps does not consider the precarious employment and other real-world barriers that often prevent them from maintaining stable work over time,” lead researcher Paul Shafer said in a news release.

“These new work requirements are going to be tougher to fulfill for people with less education, part-time jobs or gig work, who have less control over their hours, and those who have substantial health concerns that may not rise to the level of a documentable disability,” Shafer said. He is an associate professor of health law, policy and management at Boston University School of Public Health.

Single mothers with high school kids might be one of the groups hardest hit by the new requirements, Shafer said.

“Parents are only exempt if their children have a recognized disability or are under the age of 14, so single moms with older children must meet and report these work requirements to remain eligible,” Shafer said.

The Republican-enacted One Big Beautiful Bill Act mandates a reduction of nearly $1 trillion in Medicaid spending over a decade, researchers said in background notes. All Democrats voted against it.

As part of those cutbacks, new federal rules that take effect Jan. 1 mandate that adults enrolled under the Affordable Care Act’s Medicaid expansion must show that they are working, volunteering, attending school or participating in job training for at least 80 hours a month, researchers said.

The administrative burden associated with meeting and maintaining these work requirements is expected to be the main way people are driven off Medicaid rolls, researchers said.

But nearly 20% of Medicaid-eligible working people in expansion states are unlikely to fulfill the minimum required hours once the rules take effect, researchers said.

About 14% hover near the minimum hours threshold, and nearly 8% have highly inconsistent work hours, researchers found by examining data from the 40 Medicaid expansion states.

Many Medicaid recipients are subject to inconsistent and unpredictable work hours because they hold low-wage jobs in the retail, hospitality, food service, healthcare and agriculture industries, researchers said.

These workers also struggle to find reliable transportation to work and affordable child care, and frequently suffer from disabilities or health problems that make it difficult for them to work regularly.

“Ample evidence suggests supporting people through Medicaid actually helps them to have stable employment because their health is better managed,” Shafer said. “Without Medicaid coverage, it is unlikely they will be able to meet both basic and critical health needs.”

States like Connecticut, Ohio, Arkansas and Nevada had among the highest proportion of people at risk of losing Medicaid by not meeting work requirements, researchers found.

On the other hand, Massachusetts, Wisconsin, Colorado and Washington were the states with the most people likely to lose Medicaid due to variable work hours.

“Work and community engagement requirements assume Medicaid expansion eligible individuals have predictable schedules that translate into the same hours worked as scheduled,” said senior researcher David Anderson, an assistant professor of health services policy and management at University of South Carolina.

“Our study shows that this is not the case,” he said in a news release. “People who are trying to meet these requirements are at higher risk if they are limited to short look-back periods, and limited hardship exemptions.”

Researchers also found that white Medicaid recipients were more likely to lose coverage under the requirements than Black or Hispanic recipients, and that those with less than a high school diploma had a higher risk than those with more education.

The team also noted that their findings might be conservative estimates, as some states plan to determine Medicaid eligibility based on multiple months of work history prior to enrollment.

“States must look back to the prior month for compliance before the Medicaid application is filed, but they can look back as far as three months,” said researcher Timothy Callaghan, an associate professor of health law, policy and management at Boston University.

“That means that, in some states, individuals must demonstrate work over several months to qualify for benefits,” Callaghan said in a news release. “This will slow the access of newly employed individuals to Medicaid benefits in these states, and could lead to disparities in Medicaid access for those with inconsistent work.”

More information

The Center for Health Care Strategies has more on Medicaid work requirements.

SOURCES: Boston University School of Public Health, news release, Aug. 28, 2026; JAMA Health Forum, Aug. 28, 2026