Coverage Losses Predicted for Medicaid Expansion States Under Proposed Work Requirements

April 22, 2025

More than 174,000 Pennsylvanians may lose their health coverage if plans to impose work requirements come to fruition, according to a study from the Robert Wood Johnson Foundation and the Urban Institute.

The proposal would withhold federal funding for adults enrolled in Medicaid expansion who do not report working for at least 80 hours per month or meet exemption criteria, such as being a student, family caregiver, or having a disability. The analysis shows that about 5 million adults nationwide could lose Medicaid coverage under such a requirement, including working adults who may lose coverage due to confusion about the rules.

Here are a few things to know:

• Overly Complicated Process:  The study estimates that nine in 10 expansion adults ages 19 to 55 already work, participate in work-related activities, or could meet exemption criteria. They are at risk of losing coverage because of low awareness and understanding of the policy and difficulty using state reporting systems.
• Expansion States Will Suffer:  At least 10,000 adults would lose coverage in nearly every expansion state and Pennsylvania would be among a handful with more than 100,000 adults losing coverage.
• Contributing Factors:  Coverage losses could vary widely based on state Medicaid programs’ administrative capacity and how they choose to implement requirements, as well as details of the final federal legislation and regulatory guidance.

The research brief is available online.

HAP and Pennsylvania hospitals are advocating with the state’s congressional delegation to protect Medicaid and its vital role supporting access to care. See HAP’s infographic highlighting the critical importance of Medicaid to Pennsylvania and letter to the state’s congressional delegation online.