Medicaid Community Engagement Requirements and the Value of Work

Key Takeaways

Work is beneficial for adults and their children. It promotes well-being, mental health, physical health, and longevity.

• Past reforms that linked eligibility for social welfare programs to working have succeeded. They promoted working, private health insurance coverage, household income, financial stability, financial independence, and stronger families.
• Half of working-age adults (age 19-64) on Medicaid worked 20 hours or fewer per week in 2024. Even among able- bodied adults on Medicaid without children, 44 percent worked less than 20 hours per week in 2024, with 88 percent of this group not working at all.
• We estimate that federal taxpayers spent $56.1 billion on Medicaid for childless, working-age, able-bodied adults working 20 hours a week or less in 2024 alone, amounting to 11 percent of total federal Medicaid spending.
• This spending was concentrated among a few states, with California and New York costing federal taxpayers $13.5 billion and $6.4 billion in 2024 alone, respectively, accounting for over one third of the total nationwide.