{"id":210491,"date":"2025-06-24T13:38:12","date_gmt":"2025-06-24T13:38:12","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/210491\/"},"modified":"2025-06-24T13:38:12","modified_gmt":"2025-06-24T13:38:12","slug":"people-are-going-to-die-how-medicaid-work-requirements-cost-people-their-health-insurance-medicaid","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/210491\/","title":{"rendered":"\u2018People are going to die\u2019: how Medicaid work requirements cost people their health insurance | Medicaid"},"content":{"rendered":"

Kelly Fountain of central Arkansas<\/a> plans to move her family out of the state if work requirements are enacted for Medicaid<\/a>, given the issues and lack of resources she has already faced in obtaining support for her 24-year-old son with disabilities, Colby.<\/p>\n

\u201cIf Trump\u2019s budget<\/a> is passed as it is currently written, we will be leaving Arkansas,\u201d said Fountain. \u201cOur politicians here know very well that people are going to lose their Medicaid, they\u2019re depending on it. People are not only going to lose their healthcare, they\u2019re going to die.\u201d<\/p>\n

Fountain\u2019s dilemma is one that millions of Americans may face if Donald Trump\u2019s \u201cbig, beautiful bill\u201d passes through Congress in its current form. The bill will cut Medicaid across the US by 7.6 million to 10.3 million people, according to Congressional Budget Office estimates<\/a>, with the majority of the cuts as a result of work reporting requirements, increasing barriers for enrollment and renewal of Medicaid coverage, and limiting states\u2019 ability to raise state Medicaid funds through provider taxes.<\/p>\n

Medicaid recipients and advocates are warning of the negative impacts of work reporting requirements, pointing to the examples of the two states to have already tried work requirements for Medicaid, Georgia<\/a> and, briefly, Arkansas. In both states, there was a significant increase in individuals without health insurance and medical debt, and no boost in employment, one of the Trump administration\u2019s key arguments for imposing the requirements.<\/strong><\/p>\n

The Medicaid work reporting requirements would begin in December 2026, with proponents of the reporting requirement for able-bodied adults to work, volunteer or attend an education program at least 80 hours a month. The change comes after the Republican House speaker, Mike Johnson, claimed<\/a> Medicaid recipients were \u201ctaking advantage\u201d, \u201ccheating\u201d and \u201cdefrauding\u201d the system.<\/p>\n

Colby Fountain inside his apartment in West Little Rock, Arkansas, last week. Photograph: Harlan Bozeman\/The Guardian<\/p>\n

Researchers at the Yale Public School of Health estimate <\/a>the cuts to health programs, including Medicaid and Affordable Care Act marketplace unenrollment, could lead to 42,500 lost lives annually. The work requirements would require <\/a>older adults not yet eligible for Medicare, people with disabilities, and caregivers to navigate the reporting requirements to maintain Medicaid eligibility.<\/p>\n

In Arkansas, work requirements were enacted in 2018, only to be cancelled months later after a federal court stepped in to block<\/a> the requirements.<\/p>\n

Kelly Fountain\u2019s son, Colby, was born with a rare genetic condition, haploinsufficiency syndrome, and has autism and other health and developmental issues associated with the disorder.<\/p>\n

She explained the only way they were able to have the expensive genetic testing done was through Medicaid<\/a>, which they have also relied on to cover Colby\u2019s medical care.<\/p>\n

It took 13 years on a waitlist waiver program for Colby to be able to get into a community-based program where he is learning to do tasks such as grocery shop, cook, or count money, but she said the lack of resources for employment, such as support through employment and transportation, has made it infeasible for Colby to work.<\/p>\n

\u201cHe still can\u2019t work because there\u2019s no supportive employment. He would need to have staff with him the whole time he\u2019s working in order to train him properly. That does not exist here,\u201d said Fountain. \u201cAt one point in time, if we\u2019re fortunate, we\u2019re all going to be disabled at some point in our lives. We all deserve healthcare. It should not depend on whether or not we can find a job. We should be able to access healthcare when we are at our sickest and most vulnerable, and right now Congress wants to eliminate that availability.\u201d<\/p>\n

Kelly Fountain and her son Colby flip through his medical binder in West Little Rock. Photograph: Harlan Bozeman\/The Guardian<\/p>\n

About 813,000 children and adults in Arkansas are currently enrolled in Medicaid, covering over 25% of the state\u2019s population. 64% <\/a>of adults on Medicaid in Arkansas are working. Most Medicaid enrollees classified as \u201cable-bodied\u201d are predominantly older women and only comprise 15.8%<\/a> of the total non-working population of Medicaid beneficiaries between the ages of 18 to 64, according to an analysis<\/a> by the Milbank Quarterly.<\/p>\n

\u201cMost who are not working because they can\u2019t find a job, are disabled, children, or elderly,\u201d added Fountain. \u201cWe don\u2019t have consistent internet here. They don\u2019t have access to training programs, transition services, and they have understaffed<\/a> the department of health and services so badly they have to submit their paperwork three, four or five times before DHS says they received it.\u201d<\/p>\n

Arkansas\u2019s work reporting requirements pertained to adults ages 30 to 49 with no children, and led to unenrollment of 18,000 individuals<\/a> before the court blocked further implementation, while no changes to employment were recorded.<\/p>\n

Research on the requirements in Arkansas found the administrative costs<\/a> to implement the policy were $26.1m and also resulted in increased medical debt and delaying of medical care for those who lost health insurance coverage.<\/p>\n

Camille Richoux, the health policy director for Arkansas Advocates for Children and Families said the work requirements were more of a \u201cpaperwork requirement\u201d and led to confusion. She said about 95%<\/a> of individuals who lost Medicaid coverage were meeting the requirements or should have qualified for an exemption.<\/p>\n

\u201cIt was a mess,\u201d said Richoux. \u201cThe rollout was chaotic and resulted in just a massive loss of insurance. Employment did not increase, wages did not increase during this time. The only impact was more people becoming uninsured.\u201d<\/p>\n

To report their work Medicaid beneficiaries had to use a website, which was glitchy, unreliable, and poorly disseminated to the people affected, she argued.<\/p>\n

Nancy Morrell with her sister, Carolyn, at their home in Eureka Springs, Arkansas. Nancy is a live-in caregiver for her sister. Photograph: Henry O Head\/The Guardian<\/p>\n

Despite the serious issues with the requirements, Arkansas is seeking another waiver<\/a> to impose work requirements on Medicaid beneficiaries, in addition to the requirements in the federal spending bill.<\/p>\n

\u201cWe could actually have a situation in Arkansas<\/a> where we have two different work requirements with different components,\u201d added Richoux. \u201cWork requirements are not some incentive for getting a job. They\u2019re just a punishment if you don\u2019t do things right, or if you miss a paperwork, or if the state makes a lot of errors, and that can turn into an entire crisis in your life.\u201d<\/p>\n

In Georgia, work requirements enacted in July 2023 have led <\/a>to similar results, with significant barriers for Medicaid enrollment for eligible beneficiaries due to delays, application issues, and extensive administrative costs of nearly $58m<\/a>.<\/p>\n

Luke Seaborn, a 54-year-old mechanic from Jefferson, Georgia<\/a>, became the public face of Georgia Pathways to Coverage, Governor Brian Kemp\u2019s insurance program for impoverished Georgians, when it was unveiled last year. Pathways included Medicaid work requirements.<\/p>\n

Seaborn has since turned on the legislation, telling ProPublica <\/a>earlier this year his benefits were cancelled due to red tape twice in the past year. \u201cI used to think of Pathways as a blessing,\u201d Seaborn told ProPublica. \u201cNow, I\u2019m done with it.\u201d<\/p>\n

\u201cStates are not ready or equipped to implement these work requirements, and that\u2019s going to cause even more harm. What happened in Georgia was they spent all this money on paying consultants to implement a very complicated bureaucratic system to see if people are working, and it slowed down their processing of Medicaid applications and Snap [food stamps] applications for everyone else,\u201d said Natalie Kean, director of federal health advocacy at the advocacy and legal non-profit Justice in Aging, who noted the proposed Medicaid cuts are also shifting more federal costs on to states.<\/p>\n

Nancy Morrell with her sister, Carolyn, at their home in Eureka Springs. Photograph: Henry O Head\/The Guardian<\/p>\n

\u201cWe know from history, when states have budget shortfalls, they tend to cut home-based care for older adults and people with disabilities first, so even the indirect impacts of this will be really harmful,\u201d Kean added. \u201cWhat work requirements amount to are penalties for people who lose their job, or when we\u2019re thinking about older adults, for people who have to retire early or often having chronic conditions that prevent them from working full time. These requirements would mean that when you get into that situation, you also lose your healthcare, or you can\u2019t get healthcare in the first place.\u201d<\/p>\n

Back in Arkansas, Nancy Morrell, a live-in caregiver in Eureka Springs, said the push for Medicaid cuts had already affected her family. In April 2025, she was notified that the hours that Medicaid would cover for her care of her sister Carolyn, with cerebral palsy, would be reduced by 75 a month despite no changes in her care needs.<\/p>\n

\u201cI don\u2019t know why they decided to cut them,\u201d Morrell said. \u201cThere was just no sympathy, really whatsoever. It was just, this is what it is, and this is what it\u2019s going to be. And of course, they send you the papers that say that you can ask to appeal it, which is the process that we\u2019re going through right now.\u201d<\/p>\n

Morrell claimed a staffer with the Arkansas health department told her \u201cyou can be paid to feed her. You just can\u2019t be paid when she\u2019s chewing. So you have to take some time off of that.\u201d The staffer did not respond to multiple requests for comment. Arkansas department of human services declined to comment, citing confidentiality requirements.<\/p>\n

Morrell argued she takes care of her sister 24 hours a day, seven days a week, and is only compensated for eight of those hours. She views the additional cuts to those hours as a push to put her sister in a more expensive care facility.<\/p>\n

Nancy Morrell with her sister, Carolyn. Photograph: Henry O Head\/The Guardian<\/p>\n

\u201cWe take care of her 24 hours a day, but we\u2019re only paid for a third of that, basically. And yet, Medicaid is willing to cut this now,\u201d added Morrell. \u201cThe push here is for me to put Carolyn in a nursing facility where she can\u2019t even push a call button for help. She would die within a few months. Which is exactly what they want to save Medicaid funds.\u201d<\/p>\n

A spokesperson for the Arkansas department of human services claimed the waiver the state is seeking for work requirements, called Pathway to Prosperity, \u201cis an innovative new approach to a work and community engagement requirement\u201d that will assist \u201cbeneficiaries attain economic independence, and by extension improve their health. Beneficiaries who are not exempt and who actively choose not to participate in qualifying activities, which could include training, education, employment and Success Coaching, will be suspended from their Medicaid coverage.\u201d<\/p>\n

They claimed the program was \u201cinformed by lessons from Arkansas Works, but it is fundamentally different in several key ways, including the focus on data matching rather than individual reporting\u201d.<\/p>\n

The Georgia department of community health and White House did not respond to multiple requests for comment.<\/p>\n","protected":false},"excerpt":{"rendered":"Kelly Fountain of central Arkansas plans to move her family out of the state if work requirements are…\n","protected":false},"author":2,"featured_media":210492,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4316],"tags":[105,4348,16,15],"class_list":{"0":"post-210491","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-uk","11":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114738620246077392","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/210491","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=210491"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/210491\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/210492"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=210491"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=210491"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=210491"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}