Today’s rule implements a key Medicaid reform in the One Big Beautiful Bill that prioritizes work over welfare and is projected to lift millions of people out of poverty. These commonsense work requirements for able-bodied, working-age adults on Medicaid represent a critical step toward restoring Medicaid to its original purpose: serving as a targeted safety net for the most vulnerable rather than an open-ended entitlement that discourages work and strains taxpayer resources.
Work is essential for economic opportunity, self-sufficiency, and long-term human flourishing. A report released today by the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services estimates that this policy will lift two to three million Americans out of poverty.
Able-bodied adults of working age should engage in employment, job training, education, volunteering, or community service—not rely indefinitely on welfare. Public opinion strongly backs this principle, with more than 80 percent of Americans supporting work requirements for able-bodied Medicaid recipients.
Since passage of the ACA, Medicaid has expanded dramatically among non-disabled, working-age adults, with federal matching rates seven times greater for this group than for traditional enrollees such as children, pregnant women, seniors, and people with disabilities. Without reforms, this distortion of state incentives crowds out care for the truly needy. Work requirements help protect finite Medicaid resources for those who cannot work due to disability, frailty, or caregiving responsibilities, while promoting independence for those who can.
To succeed, these requirements must be effectively designed and enforced to minimize gaming and abuse. Self-attestation alone for compliance or exemptions—particularly for medical frailty—risks repeating the improper enrollment and fraud seen in other programs when verification standards were weakened. The administration’s rule strikes the appropriate balance between necessary program integrity protections and accommodations for those who genuinely need assistance.
