H.R.1 added Medicaid work requirements for low-income adults 19–64, requiring 80 hours monthly to keep benefits.
Rules began in 2026–2027 for 41 ACA expansion states, but enforcement details are left largely to states.
Projected 2026 coverage losses: 4.6–5.2M adults
By 2034: up to 5M fewer enrollees
Federal spending ↓$300–344B
States can automate verification or require manual reporting; hardship exemptions, grace periods, and re-enrollment rules shape churn.
Early pilots showed little employment or coverage gain, but more disenrollment from administrative complexity.
