In states that have long refused to expand Medicaid to more low-income adults, people in the program aren\u2019t subject to new rules under the One Big Beautiful Bill Act requiring them to prove they\u2019re working in order to get and keep coverage.<\/p>\n
That\u2019s not stopping Florida lawmakers from trying to adopt Medicaid work requirements anyway. It\u2019s the only legislative body in a nonexpansion state to even consider it so far.<\/p>\n
\u201cYou need to go to work if you want your friends and neighbors to pay for your health care,\u201d said state Sen. Don Gaetz<\/a>, the Republican sponsor of a Medicaid work requirement proposal making its way through the legislature.<\/p>\n The move baffles health care advocates and Medicaid experts. Some doubt it\u2019s even legal under President Donald Trump\u2019s signature domestic policy law.<\/p>\n \u201cYou cannot change the terms of the work requirement,\u201d said Leo Cuello<\/a>, an attorney and a professor at Georgetown University\u2019s McCourt School of Public Policy, citing guidance<\/a> issued by the Centers for Medicare & Medicaid Services. For Cuello, the answer is clear: \u201cIt\u2019s a pretty easy no.\u201d<\/p>\n <\/a>Medicaid work requirements affect Washington, D.C., and the 40 states that have expanded Medicaid eligibility to all nondisabled adults ages 19 through 64 with incomes up to 138% of the federal poverty level, as prescribed under the Affordable Care Act. That\u2019s an income of $22,025 a year for a single person.<\/p>\n Starting next January, those states must require people in their expansion groups to report at least 80 hours a month of work, education, or community service to qualify for and maintain Medicaid coverage.<\/p>\n About 4 million people are enrolled in Florida\u2019s program, and Gaetz estimates that about 147,000 of them are adults who \u201ccould work and should work.\u201d<\/p>\n They \u201care able-bodied and they don\u2019t have small children at home, and they aren\u2019t taking care of an elderly person or a disabled person,\u201d he said. \u201cYet they receive Medicaid benefits.\u201d<\/p>\n People affected by the Senate bill<\/a> would primarily be parents of children 14 and older, and some 19- and 20-year-olds, he said. A companion bill<\/a> in the Florida House would apply Medicaid work requirements to parents of children ages 6 and older.<\/p>\n To qualify for Medicaid in Florida, a working-age adult without a disability must generally be caring for a child or an older or disabled family member and cannot earn more than 26% of the federal poverty level, or about $592 a month for a family of three.<\/p>\n Most adults who are not disabled and receive Medicaid already work, and many people in low-paying jobs do not receive health insurance through an employer, according to KFF<\/a>, a health information nonprofit that includes KFF Health News. Among single adults ages 19 to 64 in Florida who made under $15,000 a year in 2024, about 17% had health insurance<\/a> through work.<\/p>\n Critics say Florida\u2019s proposal would likely force some people to become uninsured, even if they meet the work requirement. That\u2019s because the state\u2019s Medicaid income limit is so low that working the mandated 80 hours a month would likely cause those individuals to exceed the income eligibility limit but also leave them earning too little to qualify for subsidized coverage on the Affordable Care Act marketplace.<\/p>\n Michelle Mastrototaro said she lost her Medicaid coverage in November after taking a part-time job as a teaching assistant at a Tampa elementary school last year. Mastrototaro, 47, cares for a disabled teenage son and likely would not need to meet Florida\u2019s proposed work requirement.<\/p>\n But she said her biweekly wages from working about 17 hours a week pushed her past the Medicaid income limit. She has struggled to afford her prescription medications since.<\/p>\n \u201cWhat I\u2019m making is nothing,\u201d Mastrototaro said. \u201cI am scavenging just to make ends meet.\u201d<\/p>\n The Gaetz-led proposal ignores \u201cthe hard realities of what it takes to be qualifying for Medicaid in Florida,\u201d said Scott Darius<\/a>, executive director of Florida Voices for Health, a nonprofit that advocates for Medicaid expansion. \u201cOn its face,\u201d he said, \u201cit doesn\u2019t make sense.\u201d<\/p>\n Medicaid experts say the federal budget reconciliation law<\/a> holds that nonexpansion states cannot adopt work requirements.<\/p>\n A state that hasn\u2019t added more low-income adults to its Medicaid program can\u2019t impose work requirements on those who are already covered, Cuello said. States must cover specific categories of low-income people \u2014 such as children, pregnant women, some parents, older adults, and people with disabilities \u2014 to receive federal funding for their programs.<\/p>\n States that have expanded Medicaid eligibility to a limited group of low-income adults, namely Georgia and Wisconsin, will be required to impose work requirements on those enrollees.<\/p>\n Georgia\u2019s partial expansion program<\/a>, launched in July 2023, already includes a requirement that newly eligible adults report at least 80 hours of work or community engagement. Federal approval for the program expires at the end of December, and the state has applied for an extension<\/a>. Wisconsin\u2019s program<\/a> will have to implement a work requirement by Jan. 1.<\/p>\n South Carolina applied in June for federal approval to extend Medicaid eligibility<\/a> to nondisabled parents and caregivers ages 19 to 64 who earn 67-100% of the federal poverty level. That\u2019s about $18,300 to $27,300 a year for a family of three. The state\u2019s application is pending with CMS, and if approved would implement work requirements for those newly eligible adults.<\/p>\n Gaetz said if the Florida legislation were approved, the state would develop a \u201cbusiness plan\u201d for implementing work requirements and seek CMS approval.<\/p>\n It is unclear how much it would cost, but experience in states with Medicaid work requirements suggests that implementation would be expensive. States must upgrade their eligibility and enrollment systems, hire additional staff, and inform the public of the new mandate.<\/p>\n For its program, Georgia spent about $54.2 million on administrative changes out of $80.3 million in total spending for the program from October 2020 to March 2025, according to a report<\/a> from the U.S. Government Accountability Office. Most of the administrative spending \u2014 about $47.4 million, or 88% \u2014 came from the federal government.<\/p>\n Georgia\u2019s experience echoes others\u2019, according to a 2019 GAO examination<\/a> of states that received approval to implement Medicaid work requirements during the first Trump administration. That report focused on five states \u2014 Arkansas, Indiana, Kentucky, New Hampshire, and Wisconsin \u2014 and estimated costs would total $408 million. They ranged from $6 million in New Hampshire to more than $270 million in Kentucky, though those figures did not reflect all the state costs.<\/p>\n Florida\u2019s computer infrastructure for collecting and verifying information and determining eligibility is more than 30 years old and is being replaced. That is anticipated to be completed in 2028 and cost more than $180 million.<\/p>\n A legislative analysis of Gaetz\u2019s bill estimated that if 1 in 4 people affected by the proposed work requirement were to lose Medicaid coverage, the state could save about $80 million a year.<\/p>\n Darius, with Florida Voices for Health, said those potential savings hardly seem worth the effort.<\/p>\n \u201cIt requires the state to build this giant regulatory-like framework and to rebuild systems, and to employ a whole set of people to chase down the very small number of folks who would ultimately be touched by this,\u201d he said.<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage? <\/em>Click here<\/em><\/a> to contact KFF Health News and share your story.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n