New Medicaid Work Rules Pose Risks to Middle-Aged Adults

New federal rules requiring work or qualifying activities for Medicaid recipients are raising concerns that middle-aged adults, particularly women, will be disproportionately affected. Whereas proponents argue these rules promote self-sufficiency and the long-term sustainability of Medicaid, critics warn they could lead to coverage losses for vulnerable individuals facing health challenges and caregiving responsibilities.

The Changing Landscape of Medicaid Eligibility

Starting in January 2026, approximately 20 million low-income Americans across 42 states and Washington, D.C., will be required to demonstrate at least 80 hours of work, volunteering, schooling, or other qualifying activities each month to maintain their Medicaid coverage. This policy shift comes after Republican lawmakers expressed concerns about potential abuse of the program, with some suggesting that able-bodied individuals were unnecessarily relying on government assistance. House Speaker Mike Johnson previously stated that Medicaid is not intended for “29-year-traditional males sitting on their couches playing video games” (CBS News).

Who is Most at Risk?

However, analysis from the KFF (Kaiser Family Foundation) indicates that the impact of these rules will likely fall hardest on adults aged 50 to 64, especially women. Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, explains that many in this demographic face barriers to meeting the work requirements due to health issues or caregiving obligations (NC Newsline).

Lori Kelley’s Story

Lori Kelley, a 59-year-old resident of Harrisburg, North Carolina, exemplifies these challenges. Deteriorating vision forced her to close her nonprofit circus arts school and limit her work to sorting recyclable materials at a local concert venue – a job that isn’t available year-round. She relies on Medicaid for coverage of medications for arthritis and anxiety, as well as management of high blood pressure. Kelley expresses fear about losing this vital coverage under the new rules, stating, “I’m scared right now” (NC Newsline).

Caregiving and Limited Work Opportunities

Many middle-aged women are less likely to meet the work requirements as they serve as family caregivers for children or aging parents. Researchers at the University of Massachusetts Boston found that only 8% of the Medicaid population is considered “able-bodied” and not working, with a significant portion being women who have left the workforce to provide care (NC Newsline). Advocates worry that exemptions for caregivers within the new law are too narrow, potentially leaving many vulnerable individuals without coverage.

Paula Wallace, 63, of Chidester, Arkansas, is another example. She recently gained Medicaid coverage but is concerned about meeting the work requirements while caring for her husband, who has advanced cirrhosis. Despite her husband’s eligibility for Social Security Disability Insurance, which should qualify her for an exemption, Wallace is uncertain about navigating the complex system to prove her caregiving status (CBS News).

Potential Consequences and Economic Impact

The nonpartisan Congressional Budget Office projects that these work rules could result in at least 5 million fewer people with Medicaid coverage over the next decade (NC Newsline). Critics argue that these coverage losses are a deliberate attempt to reduce government spending, even at the expense of people’s health. Jane Tavares, a gerontology researcher at the University of Massachusetts Boston, stated, “We’re talking about saving money at the expense of people’s lives” (NC Newsline).

losing Medicaid coverage could ultimately increase healthcare costs in the long run. If individuals delay or forgo necessary medical care due to lack of insurance, their health conditions may worsen, leading to more expensive treatment when they eventually qualify for Medicare.

States Exempted from the New Rules

Eight states – Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming – did not expand their Medicaid programs under the Affordable Care Act and are therefore exempt from implementing these new work requirements (NC Newsline).

The Department of Health and Human Services maintains that the work requirements are intended to ensure the long-term sustainability of Medicaid while protecting coverage for those most in need, with exemptions for individuals with disabilities, caregivers, pregnant individuals, and veterans (NC Newsline).