The United States Senate narrowly passed on Tuesday the One Big Beautiful Bill Act, a national budget bill that includes many of the key policies of President Donald Trump’s (R) second term agenda.
After Vice President J.D. Vance cast the tie breaking vote, the Senate’s version of the bill was sent back to the House where it originated for concurrence, a final hurdle on the road toward passage.
Proposed changes to Medicaid have been among some of the most controversial aspects of the bill. While opponents have argued that they would have a negative impact on vulnerable populations, supporters have said that it would strengthen the program for those who rely on it most.
The establishment of work requirements for certain Medicaid recipients has perhaps been one of the most heavily discussed elements of the One Big Beautiful Bill Act’s Medicaid reform efforts.
Under both the House and Senate versions of the bill, work requirements would be instituted for many able-bodied adults seeking Medicaid coverage.
Excluded from these requirements, however, would be seniors age 65 and older, as well as pregnant women and parents of children younger than 14, among others.
This is a bit more restrictive than the version of the bill previously advanced in the House, which would have exempted anyone caring for dependent children of any age.
In order to be maintain eligibility for Medicaid under this bill, non-exempted individuals would need to work, volunteer, or go to school for at least 80 hours per month.
The Washington Post reports that those seeking an exemption would need to submit proper paperwork proving their eligibility to receive Medicaid despite not meeting this requirement.
KFF, a nonprofit provider of health policy research, found in a recent study that the majority of Medicaid recipients are already participating in the workforce.
44 percent work full-time and an additional 20 percent work part-time, while another 7 percent are not working due to school attendance. This represents 71 percent of Medicaid enrollees.
The remaining 29 percent are unemployed largely due to caregiving responsibilities (12 percent) or an illness or disability (10 percent). Everyone else is either retired, unable to find work, or unemployed for an unspecified reason.
According to NBC News, it is estimated that 18.5 million Americans receiving Medicaid would be subject to these new requirements.
The Congressional Budget Office (CBO) has estimated that under this policy, 5.2 million fewer adults would be enrolled in Medicaid by 2034, increasing the total number of uninsured people by 4.8 million due to a lack of access to other insurance options.
KFF reported in a June 2025 study that these work requirements, as approved in the House, would save the country $344 billion over 10 years, the largest source of savings in the bill.
The CBO has said projected that this change will save the country about $325 billion over the course of a decade.
While critics have argued that instituting work requirements would have a negative impact on vulnerable individuals seeking coverage, supporters have said that it is a key part of ensuring the long-term sustainability of Medicaid for those who need it most.
“Will the work requirements as the House and Senate have drafted them result in some people not enrolling in Medicaid? Yeah, probably,” Michael Cannon, Director of Health Policy Studies at the Cato Institute, told Fox Business in a recent interview. “There is no obvious way to strike a balance between helping too much and helping too little, but a work requirement is a perfectly reasonable one.”
Similar sentiments have been echoed by the White House in response to criticism of the move.
“This bill protects Medicaid…for those who truly deserve this program, the needy, pregnant women, children and sick Americans who physically cannot work,” press secretary Karoline Leavitt told reporters during a recent briefing. “It ensures that able-bodied Americans who can work 20 hours a week are actually doing so, and that will therefore strengthen and protect those benefits for Americans who need it.”
Maine Sen. Susan Collins (R), who voted against the bill’s passage in the Senate Tuesday, noted in her statement explaining her reasoning that despite her opposition to the bill, she supports the implementation of Medicaid work requirements.
“Certainly, there are improvements that should be made to the Medicaid system,” Sen. Collins wrote on X Tuesday. “For example, I support work requirements for able-bodied adults who are not raising young children, who are not caregivers, or attending school.”
A study published by the UC Berkley Labor Center in June of this year concluded that the institution of work requirements could have an outsized impact on older Medicaid recipients due to caregiving responsibilities and cumbersome amounts of paperwork.
This study also details how individuals over the age of 50 are far less likely to work than their younger counterparts, pointing toward factors such as chronic health issues and alleged age discrimination.
A KFF study published in February of this year suggests that work requirements do little to increase employment rates among those otherwise eligible for Medicaid — pointing toward already significant levels of employment in this sub-group — while simultaneously leading to an increase in the number of uninsured individuals.
A report published by the Heritage Foundation in 2023, however, highlights how work requirements are a widely supported policy among Americans and suggests that they help to reduce unnecessary enrollments in the program.
Another 2023 report from the Heritage Foundation details how work requirements can be seen as key to vulnerable Americans’ “long-term well-being,” as higher employment rates are connected with a reduction in single-parent households and an increase in overall family well-being.
Former Director of the California Labor Department Michael Bernick recently wrote an op-ed in the LA Times arguing in support of work requirements, suggesting that “Medicaid work rules are not cruel or punitive,” but rather that “they help Americans to reclaim the power of the job.”
According to Bernick, work rules help provide a “push” into the job market that some beneficiaries may need due to a “lack confidence, [having] become discouraged or [having] no idea how to get started.”
Should this bill make it to the President’s desk, the proposed work requirements would take effect beginning in 2026.
