Medicaid Bombshell: Work Mandates Go National

Stethoscope pen document about Medicaid eligibility on table

A new federal law threatens Medicaid access, aligning with Georgia’s controversial work requirement model.

Story Overview

Trump’s administration introduces national Medicaid work requirements.
Georgia’s Medicaid waiver program serves as the federal model.
Criticism arises over administrative challenges and low enrollment in Georgia.
Federal law mandates similar systems across Medicaid expansion states.

Georgia’s Medicaid Model Goes National

On July 4, 2025, President Trump signed the “One Big Beautiful Bill” (OBBB) into law, enforcing national Medicaid work requirements inspired by Georgia’s Medicaid waiver program. Georgia’s unique approach, which includes work or community engagement mandates as a condition for Medicaid access, faced significant scrutiny but ultimately influenced this federal initiative. The Trump administration extended Georgia’s Medicaid waiver through December 2026, providing a template for other states to follow. This move underscores a significant shift towards conservative health policy goals.

Georgia’s program, known as “Pathways to Coverage,” mandates enrollees to complete 80 hours per month of work, education, or volunteering. Despite the intention to promote self-sufficiency, the program has been criticized for its low enrollment numbers and high administrative costs. As of May 2025, only 7,463 individuals were enrolled, far short of the 25,000 initially projected. Critics argue that these requirements create unnecessary barriers to healthcare access, especially for low-income adults with unstable employment.

Implications for Medicaid Expansion States

The new federal law now requires all Medicaid expansion states to implement similar work requirements by January 2027. This policy change is expected to impose significant administrative burdens on state Medicaid agencies, which must develop systems to monitor compliance. The Congressional Budget Office allocated $200 million to support these implementations, but concerns remain about potential coverage losses and increased uninsured rates.

Advocacy groups, such as the Georgia Budget & Policy Institute, have voiced concerns over the inefficiency and accessibility of Georgia’s model. They warn that replicating this model nationwide may exacerbate existing health disparities, particularly affecting vulnerable populations who struggle with employment stability and documentation. These concerns highlight the ongoing debate over the balance between promoting self-reliance and ensuring accessible healthcare for all.

Administrative Challenges and Criticisms

Despite the Trump administration’s confidence in technology to streamline implementation, Georgia’s experience reveals significant challenges. The state’s waiver program faced delays and legal battles, reflecting the complexities of administering such requirements. Critics argue that the federal government’s reliance on technology might not sufficiently address these issues, pointing to Georgia’s ongoing administrative hurdles.

Mehmet Oz, head of the Centers for Medicare & Medicaid Services (CMS), remains optimistic about the program’s potential, asserting that lessons learned from Georgia will inform smoother national implementation. However, healthcare advocates caution that administrative complexities could lead to coverage disruptions and increased financial insecurity for low-income families.