As Congress debates implementing work requirements for Medicaid, past state experiences provide a cautionary tale. Our analysis examines the potential impact if work requirements, modeled on the 2023 Limit, Save, Grow Act, were applied nationwide to adults ages 19 to 55 under Medicaid expansion.

Using data from Arkansas and New Hampshire, where similar policies led to significant disenrollment, we estimate that between 4.6 and 5.2 million Medicaid expansion enrollees—34% to 39% of the eligible population—could lose coverage in 2026. Even though 91% of those affected are already working, caregiving, or in school, many would fail to meet reporting requirements due to administrative barriers.

States could mitigate some losses through automatic exemptions based on existing data, but disparities would persist. If work requirements extend beyond expansion enrollees or if exemption criteria tighten, coverage losses could be even higher.

The stakes are clear: Medicaid disenrollment would lead to more uninsured adults, greater unmet medical needs, and increased financial hardship. As lawmakers consider new policies, lessons from Arkansas and New Hampshire underscore the real-world risks of bureaucratic barriers to essential healthcare coverage.

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