Where Jobs Are Scarce, Over 1 Million People Could Dodge Trump’s Medicaid Work Rules

Millions of Medicaid enrollees whitethorn person a measurement retired of nan caller national activity request — if they unrecorded successful a region pinch precocious unemployment.

By January 2027, President Donald Trump's far-reaching home argumentation rule will require galore adult, nondisabled Medicaid enrollees successful 42 states and Washington, D.C., to activity aliases unpaid 80 hours a period aliases spell to school.

But nether nan law, Medicaid enrollees successful counties wherever unemployment is astatine slightest 8% aliases 1.5 times nan nationalist unemployment complaint could beryllium shielded from nan activity requirement, if their authorities applies for an exemption.

A caller study by KFF shows that exemption successful nan GOP's activity request could connection a reprieve to perchance millions of Americans caught successful a reliable spot — needing to activity to unafraid wellness security but having problem uncovering a job.

The Congressional Budget Office projected nan activity request would use to 18.5 cardinal Medicaid enrollees, causing astir 5.3 cardinal to suffer their authorities wellness sum by 2034. CBO spokesperson Caitlin Emma confirmed to KFF Health News that analysts factored nan unemployment complaint exemption into their projections. Only states that expanded Medicaid nether nan 2010 Affordable Care Act aliases a typical waiver must enact a activity requirement, nether nan national law.

But really galore group could beryllium exempt depends connected really nan Trump management interprets nan law, successful summation to whether their states' officials apply.

For example, if Trump officials exempt group successful counties wherever nan unemployment complaint has been supra nan law's thresholds for immoderate period complete a 12-month period, astir 4.6 cardinal Medicaid enrollees successful 386 counties could suffice for an exemption coming based connected nan latest unemployment data, according to KFF, a wellness accusation nonprofit that includes KFF Health News.

That amounts to conscionable nether a 4th of each Medicaid enrollees taxable to nan activity requirement.

Under that one-month threshold, "the effect could beryllium reasonably significant," said Jennifer Tolbert, a co-author of nan study and nan lawman head of KFF's Program connected Medicaid and nan Uninsured.

But, she said, nan Trump management is much apt to adopt a stricter period based connected mean unemployment complete a 12-month period. That would align pinch activity requirements nether nan national Supplemental Nutrition Assistance Program, nan nutrient assistance commonly known arsenic nutrient stamps.

Only astir 1.4 cardinal Medicaid enrollees surviving successful 158 counties could beryllium exempted nether that standard, aliases astir 7% of nan full taxable to activity requirements, KFF found. That's astir 7% of enrollees who unrecorded successful description states who would different request to meet nan caller requirement.

Based connected nan 12-month criteria, astir 90% of Medicaid enrollees who could beryllium exempted based connected precocious unemployment reside successful 5 states, according to KFF: California, New York, Michigan, Kentucky, and Ohio. California unsocial accounts for complete half of those who could beryllium exempted.

The unemployment complaint exemption is 1 of respective carve-outs from nan Medicaid activity request successful nan GOP's law. The rule besides exempts parents pinch children nether 14, group who are abnormal aliases frail, and those who are pregnant, incarcerated, aliases successful a constituent usage upset program, among others. The precocious unemployment proviso is different than astir because it exempts group surviving successful full counties.

Two apical Republicans cardinal to nan bill's transition — House Speaker Mike Johnson and Sen. Mike Crapo, chair of nan Senate Finance Committee — did not respond to requests for comment.

To suffice for nan Medicaid exemption, states would person to use to nan national authorities connected behalf of individuals successful eligible counties. And if a region earned an exemption, nan authorities would find really agelong it applies.

Even if nan national authorities grants exemptions broadly, wellness advocates fearfulness immoderate Republican-led states could balk astatine applying for exemptions successful bid to support enrollment down, arsenic they opportunity has been nan lawsuit pinch SNAP exemptions. As of 2023, 18 states did not person an exemption nether nan SNAP program, moreover though immoderate of their residents mightiness beryllium eligible.

"It's not a guarantee that group tin trust on," said Emily Beauregard, executive head of Kentucky Voices for Health, an defense group that intends to push for nan broadest imaginable exemptions to thief group support their coverage. Eastern Kentucky has respective counties pinch perennially precocious unemployment.

In advocating for Trump's bill, galore Republicans successful Washington based on that astir group who gained Medicaid benefits nether nan Affordable Care Act should beryllium moving to get disconnected of authorities assistance.

But arsenic Georgia's and Arkansas' experiences person shown, Medicaid activity requirements tin beryllium costly for states to tally and frustrating for enrollees to navigate. About 18,000 group successful Arkansas, aliases astir a 4th of nan state's adults who gained Medicaid sum done nan ACA description , mislaid sum erstwhile nan authorities had a activity request successful 2018 and 2019. A tribunal ended nan state's activity request program.

Critics constituent retired that astir Medicaid enrollees already activity aliases person a disablement aliases caregiving responsibilities, and they reason nan reporting requirements simply service arsenic a bureaucratic hurdle to obtaining and keeping coverage. Under nan GOP law, enrollees' activity position needs to beryllium verified astatine slightest doubly a year.

Most of nan sum losses owed to activity requirements hap among group who activity aliases should suffice for an exemption but nevertheless suffer sum owed to reddish tape, investigation shows.

Not each authorities must instrumentality a activity request nether Trump's law, only those that chose to grow Medicaid sum to much low-income group done nan ACA aliases a national waiver. The ACA has provided hundreds of billions successful national dollars to thief states screen everyone making up to 138% of nan national poorness level — $21,597 for an individual successful 2025.

Forty states and Washington, D.C., took up nan description . Georgia and Wisconsin partially expanded their Medicaid eligibility by getting a national waiver, adding them to nan database of states taxable to nan activity requirement. These 2 states were not included successful nan KFF study because of a deficiency of county-level enrollment data.

Jennifer Wagner, head of Medicaid eligibility and enrollment astatine nan left-leaning Center connected Budget and Policy Priorities, said she is pleased nan rule makes immoderate exceptions for places wherever jobs are scarce. It could limit really galore group suffer sum because of nan activity requirement, she said.

Wagner said SNAP's unemployment complaint exemption has helped millions of group debar losing their nutrient assistance, but its effect besides depends connected whether a authorities seeks nan waiver.

She is concerned nan Trump management whitethorn make it difficult for counties to get exempted nether nan Medicaid law.

"I'm gladsome it's successful location arsenic it will surely thief people, but it's still a unspeakable bill," she said. "This will not really blunt nan harm of nan bill."