URGENT: Proposed Medicaid Work Requirements – Ask Your Lawmakers: Where Are the Jobs?

Millions of Americans are at risk of losing healthcare under a new federal proposal that would force Medicaid recipients to work, despite a nationwide job shortage.

This morning, while reviewing the Federal Register, I came across Document Identifier: CMS-10341 (90 FR 8800, Document Number 2025-02168) from the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). This document, currently in the public comment stage, proposes a new rule that could drastically alter Medicaid access by tying eligibility to work requirements.

Once again, the federal government is pushing the narrative that Medicaid recipients must “earn” their healthcare by working a set number of hours per month. This idea might seem logical at first glance, if the U.S. had a single-payer system where everyone paid into the program equally. But we don’t. Despite decades of advocacy from the left for universal healthcare, Medicaid remains a patchwork safety net, designed for those with low income, disabilities, and caregiving responsibilities, not a workforce program.

The rhetoric behind these work requirements suggests that Medicaid enrollees are lazy, unwilling to work, and dependent on government assistance. But the facts tell a different story:

✔ Most Medicaid recipients already work, yet their wages aren’t enough to survive on, forcing them to rely on public healthcare.
✔ Those who don’t work often can’t, they are disabled, caregivers, or suffering from major health conditions, a reality this proposal fails to address entirely.
✔ How do you force someone with a major medical condition to work? What about those who are bedridden or have lost limbs serving this country? Are they supposed to miraculously find jobs that accommodate them?

This isn’t about encouraging work, it’s about stripping healthcare away from vulnerable Americans under the guise of “personal responsibility.” And here’s the real problem:

The Jobs Don’t Exist

• There aren’t enough jobs to meet these requirements. If every unemployed Medicaid enrollee applied for every available job, hundreds of thousands would still be left jobless, and lose healthcare as a result.
• Major corporations like Walmart, Amazon, and McDonald’s benefit the most from Medicaid because they pay poverty wages, relying on taxpayer-funded programs to subsidize healthcare for their workers. These multi-billion dollar companies profit, while taxpayers foot the bill.
• The numbers don’t lie, Medicaid work requirements will cut people off from healthcare, not help them find jobs.

The Reality in Republican-Led States Pushing This Policy

Let’s take a look at the very states pushing this legislation, states that already have poor living conditions, low wages, and inadequate worker protections.

Even if every single job opening in these states was exclusively given to a Medicaid recipient (which is impossible), hundreds of thousands would still be left without work and without healthcare.

Who’s Actually Gaming the System? Not Medicaid Recipients, Corporations Are.

Yet, large corporations are exempt from this conversation.

• These companies pay poverty wages and exploit complex tax loopholes to avoid paying into the very system their workers rely on.
• Many of them contribute almost nothing to Medicaid, even as their employees depend on it for survival.
• The government isn’t forcing these businesses to raise wages or provide healthcare benefits, it’s punishing workers for being underpaid.

Instead of addressing the real issue, low wages and job scarcity, this policy blames Medicaid recipients for an economy that is failing them.

If this policy takes effect, millions could lose healthcare, not because they refused to work, but because the jobs they need to meet the requirement simply do not exist.

Policy Content & Intent – What Is Changing?

Under the proposed rule, the Centers for Medicare & Medicaid Services (CMS) is allowing states to require Medicaid recipients to work as a condition of eligibility.

Current Policy (2024):

✅ Medicaid is based on income, not employment.
✅ Many recipients already work but qualify due to low wages.
✅ No federal mandate requires Medicaid recipients to work.

⚠️ Proposed Policy (2025):

❌ States can impose work requirements (80 hours/month = 20 hours/week).
❌ Recipients must prove they are working or engaged in job-related activities.
❌ Failure to comply = loss of Medicaid coverage.

States can choose whether to apply these restrictions. But history tells us that Republican-led states will rush to adopt them, as many did under Trump’s first administration.

Historical Context – Why Do These Safety Nets Exist?

The push for Medicaid work requirements isn’t just an attack on healthcare, it’s an attempt to undo nearly a century of social protections designed to prevent economic collapse and mass suffering. These protections were created for a reason, and every time they’ve been weakened, Americans have paid the price.

Lessons from the Great Depression: Why Medicaid Exists

Before the Great Depression, there were virtually no federal safety nets for Americans. If you lost your job or got sick, you were on your own. The economic crash of 1929 led to:

• 25% unemployment nationwide, millions of families were left homeless, starving, and without medical care.
• Mass bankruptcies and economic collapse, with the U.S. banking system on the verge of total failure.
• Widespread disease and suffering, as millions couldn’t afford doctors, hospitals, or basic medicine.

The New Deal, spearheaded by Franklin D. Roosevelt, created America’s first major social safety nets to prevent this from happening again. Programs like Social Security, unemployment insurance, and later, Medicare and Medicaid, were built on a simple principle:

When people fall on hard times, society has a responsibility to ensure they don’t fall into total ruin.

Medicaid, created in 1965 under President Lyndon B. Johnson’s “Great Society” programs, was meant to ensure low-income Americans, people with disabilities, and caregivers had access to healthcare, so that medical bankruptcy and untreated illness wouldn’t push people deeper into poverty.

But in 2018, the Trump administration tried to roll back these protections, reintroducing work requirements for Medicaid.

The Results? A Disaster.

• Arkansas implemented work requirements, and over 18,000 people lost healthcare within months.
• Courts struck down these policies, ruling they were designed not to improve health outcomes, but to cut people off from Medicaid.

Yet in 2025, states like Arkansas, Georgia, Iowa, and South Carolina are trying again, despite historical precedent showing these policies fail.

The Financial Crises of Modern Times – The Cost of Weakening Safety Nets

The Great Depression isn’t the only time America has been brought to the brink. In modern times, financial crises have shown again and again why safety nets like Medicaid are critical to preventing economic disaster.

The Great Recession (2008-2009): Millions Lost Everything

• 9 million Americans lost their jobs.
• 10 million families lost their homes to foreclosure.
• Medical bankruptcies skyrocketed, with nearly 2 million people losing their healthcare coverage just in 2009.
• Medicaid expansion in later years helped millions recover, but the damage was already done.

Had stronger social protections been in place, millions could have avoided poverty, homelessness, and bankruptcy.

COVID-19 Pandemic (2020-2021): A Global Health and Economic Collapse

• 20 million Americans lost their jobs in just three months, the largest unemployment spike in U.S. history.
• Congress expanded Medicaid and unemployment benefits, preventing millions from falling into poverty.
• Without Medicaid, millions of Americans would have had no healthcare during the worst public health crisis in a century.

The government had to step in to save people, because the private sector failed to provide stability. Medicaid, unemployment benefits, and emergency aid kept millions afloat, but even then, many were still left behind.

History is Repeating Itself, But This Time, We Have a Chance to Stop It

What happens if another financial crisis hits? If Medicaid work requirements are implemented before the next economic collapse, how many people will be forced to choose between healthcare and survival?

The lessons of history are clear:

• Medicaid was created to prevent economic and public health disasters.
• Every time these protections have been weakened, working Americans have suffered.
• Every modern financial crisis has shown that stronger safety nets save lives and stabilize the economy.

If we let these protections be dismantled, what happens next? Are we willing to risk another economic collapse, just to score political points?

Broader Policy Context – How Does This Fit Into the Bigger Picture?

The proposed Medicaid work requirements are not an isolated decision, they align directly with Project 2025, a far-reaching policy blueprint designed to restructure federal programs and shift social safety net responsibilities to the states.

This isn’t about reducing fraud or incentivizing work, it’s a calculated effort to gut Medicaid and push people out of government programs.

Project 2025’s Plan for Medicaid

Project 2025 explicitly calls for:

✔ Shrinking Medicaid funding through block grants and per capita caps, reducing federal spending and shifting financial responsibility to states​.
✔ Eliminating “welfare dependency” by restricting eligibility and imposing work requirements​.
✔ Forcing able-bodied recipients to contribute to their healthcare costs, increasing premiums and co-pays​.
✔ Introducing “lifetime caps” on Medicaid benefits, disincentivizing long-term enrollment​.
✔ Dismantling federal oversight by allowing states to bypass existing Medicaid rules without federal waivers​.

Direct Quotes from the 2025 Mandate

On Block Grants and Funding Cuts

“Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services.” .

On Work Requirements and Lifetime Limits

“Clarify that states have the ability to adopt work incentives for able-bodied individuals (similar to what is required in other welfare programs) and the ability to broaden the application of targeted premiums and cost sharing to higher-income enrollees.”​

“Add targeted time limits or lifetime caps on benefits to disincentivize permanent dependence.”​

On Reducing Medicaid Benefits

“Increase flexible benefit redesign without waivers. CMS should add flexibility to eliminate obsolete mandatory and optional benefit requirements and, for able-bodied recipients, eliminate benefit mandates that exceed those in the private market.”​

On Pushing People into Private Insurance Instead of Medicaid

“CMS should launch a robust ‘personal option’ to allow families to use Medicaid dollars to secure coverage outside of the Medicaid program.”​

The Backdoor Strategy to Dismantle Medicaid

The work requirement policy is not about ensuring people get jobs, it’s a mechanism to shrink Medicaid rolls by making it harder to stay enrolled.

• States will have more control over eligibility, funding, and requirements, allowing fewer people to qualify for Medicaid.
• Work requirements will function as a purge mechanism, cutting hundreds of thousands of enrollees without offering them real job opportunities.
• Lifetime caps and cost-sharing rules will drive even more people out, turning Medicaid into a limited-time program rather than a safety net.

This is not reform, this is an intentional restructuring of Medicaid to ensure fewer people can use it.

The public has until March 5, 2025, to submit comments before this rule is finalized. The question remains: How many people will lose healthcare before lawmakers admit what this policy is really about?

Take Action Before It’s Too Late – Public Comment Ends March 5, 2025

The public still has a chance to fight back before this rule is finalized. The deadline to submit comments is March 5, 2025.

Here’s how you can act NOW:

✔ Read the whole document here → https://www.federalregister.gov/documents/2025/02/03/2025-02168/agency-information-collection-activities-submission-for-omb-review-comment-request
✔ Submit a public comment → Click here to submit
✔ Call your representatives and demand they oppose Medicaid work mandates.
✔ Share this article, the more people who know, the stronger the opposition.

State-by-State Breakdown – Are There Enough Jobs?

The Reality: There Aren’t Enough Jobs

In every state, there are NOT enough jobs for unemployed Medicaid enrollees.

• Even if every single available job was filled only by Medicaid recipients, thousands would still be left unemployed, and lose healthcare as a result.

Minimum Wage vs. Living Costs – The Working Poor & Medicaid Dependence

Many Medicaid recipients already work, but their low wages force them to rely on public healthcare.

What This Means

• Even full-time workers can’t afford basic living costs.
• Low-wage employers depend on Medicaid to fill the gap.
• Work requirements won’t reduce Medicaid enrollment, they will just push people deeper into poverty or out of the system entirely.

Who benefits? Not workers. Corporations like Walmart, Amazon, and McDonald’s, whose employees make up a large share of adult Medicaid enrollees because they aren’t paid enough to survive.

Predicted Outcomes & Probability Estimates

Call to Action – What Can You Do?

This rule is NOT FINAL YET – The public has until March 5, 2025, to act.

How to Fight Back:

✔ Submit a public comment → Click here to submit
✔ Call your representatives and demand they oppose Medicaid work mandates.
✔ Share this article to spread awareness.

FINAL QUESTION: Where Are the Jobs?

If lawmakers are forcing Medicaid recipients to work, then they need to show us where the jobs are. Because right now, the math doesn’t add up, and millions are at risk of losing their healthcare for no reason other than political gamesmanship.

Citations & Relevant Links

Federal Register & CMS Documentation

• CMS Proposed Rule – Federal Register
• Official Medicaid Program Information

Data on Medicaid Recipients & Employment

• Medicaid and Work Requirements – KFF
• Medicaid Enrollment Dashboard
• BLS State Employment Data
• Arkansas’ Work Requirements & Coverage Loss

The Corporate Connection: Low Wages & Medicaid Dependence

• GAO Report: Medicaid and Employer Benefits
• Corporations & Medicaid – NYT

Historical Context: Why Medicaid & Safety Nets Exist

• The Great Society & Medicaid – SSA
• New Deal History – Library of Congress
• Medicaid & the 2008 Crisis – NBER
• Medicaid & the Pandemic Response – Brookings Institution

Project 2025 & the Political Agenda Behind This Policy

• Project 2025 Official Site
• Project 2025 Policy Blueprint
• CBPP Report on Work Requirements

Public Comment & How to Take Action

• Submit Your Public Comment Here
• Find Your Representatives