California Braces for Impact of New Medicaid Work Requirements
The first mandated job requirement for Medicaid approval, introduced by a Republican-led Congress and signed into law by President Trump, is anticipated to significantly affect California.
State health officials estimate that as many as 3.4 million individuals may lose their insurance due to what Governor Gavin Newsom has dubbed the “manual verification maze.”
“We cater to about 2.3 million MEDI-CAL patients,” explained Martha Santanatin, who leads a health plan serving Los Angeles County. She projects that roughly 1 million individuals, or around 20% to 40% of their members, could lose coverage.
The new work requirements mean that Medicaid recipients nationwide, particularly those with disabilities, will have to navigate uncharted territory. It’s still unclear how California’s 5.1 million Medi-Cal beneficiaries will need to demonstrate their employment status to qualify for coverage.
Post-2026 midterm elections, millions of healthy adults will be required to provide proof of employment every six months to remain eligible for Medicaid. There are a few exceptions, such as for pregnant individuals, those in addiction treatment, or caregivers for children under 14.
Democrats have long contended that such job mandates often result in eligible individuals losing health coverage due to bureaucratic obstacles. On the other hand, Republicans believe these requirements motivate healthy individuals to seek employment and ensure that Medicaid remains available for those in genuine need.
“Clear the system and you’ll save a lot of money,” said Louisiana House Speaker Mike Johnson. “It brings back the dignity of work—encouraging young people to engage instead of gaming all day.”
Only a handful of states, including New Hampshire, Arkansas, and Georgia, have attempted to enforce job requirements for Medicaid recipients. In Arkansas, for instance, approximately 18,000 individuals lost their health coverage during the initial three months of the program.
Joan Alker, a Medicaid expert at Georgetown University, noted that people might lose their coverage for various reasons. Some may assume they are ineligible after hearing about rule changes, while others struggle to prove their status due to fluctuating incomes or unconventional payment methods. Technical challenges and confusion over forms also contribute to the problem.
With 15 million people enrolled in California’s Medi-Cal, about one-third will need to prove they are working, as per state regulations. These individuals typically earn very low incomes—less than $21,000 for individuals or $43,000 for a family of four.
The state’s prediction of 3.4 million could be informed by similar situations in Arkansas and New Hampshire, but those programs were brief and faced legal challenges, lacking nationwide best practices, according to Ryan Long from the Paragon Health Institute.
Long suggested that by putting a national focus on technological advancements in job verification, barriers could be reduced. He remarked that part of the budget proposal includes a $200 million grant to help states update their systems.
Long dismissed claims from liberal groups that this would result in widespread loss of health care as a “strawman argument,” asserting they recognize the necessity for work requirements.
A recent poll from the KFF Research Group showed that 62% of American adults support Medicaid eligibility linked to work requirements. However, many respondents believed that most people on Medicaid are already employed and could face challenges satisfying the bureaucratic demands for certification.
In June, Newsom cautioned that Californians might need to fill out extensive 36-page forms to maintain their insurance. He showcased piles of documents to underline the complexities involved in eligibility verification.
Currently, the specific systems required for proving job eligibility remain uncertain, as federal guidelines won’t be clarified for several months. Newsom’s office has directed inquiries to the Ministry of Health Services, which stated they are still assessing the operational impact of these work mandates.
Georgia is the only state to have successfully instituted permanent work requirements for Medicaid. In this state, individuals must work at least 80 hours a month and earn less than the federal poverty level to qualify for healthcare benefits. Since launching in July 2023, more than 100,000 applications for coverage have been submitted.
The Medicaid program has incurred over $100 million in costs, with $26 million allocated to health benefits and more than $20 million spent on outreach efforts. This has prompted Georgia Democrats to call for an investigation into the program’s implementation.
In California, the Inland Imperial Office, which covers about 1.5 million residents in San Bernardino and Riverside counties, estimates that around 150,000 members could be affected by the new work requirements.
Jarrod McNaughton, CEO of the Inland Empire Health Plan, expressed concern about the lack of guidance regarding the eligibility process. Key questions remain: Will it be online? Will recipients have to mail in forms? “We’re still figuring it all out,” he said.
In the interim, the Health Planning Foundation is striving to minimize the burden of compliance, enhancing community outreach to connect beneficiaries with volunteer opportunities and support.
