Medicaid Work Requirements Face Scrutiny as Job Support Falls Short for Enrollees
For years, Eric Wunderlin struggled to hold steady employment. Living in Dayton, Ohio, and battling both depression and diabetes, he bounced between part-time, minimum-wage retail jobs that barely paid enough to cover rent—often forcing him to choose between feeding himself or his cat, Annabelle.
That changed in 2018 when his Medicaid health plan through CareSource offered him something more than coverage: opportunity. The plan connected him with a life coach who helped him land a full-time job with health benefits. Today, Wunderlin works at a nonprofit social services agency and, for the first time in his adult life, is financially stable enough to dream of taking a vacation to Europe.
“I finally feel like a real person who can go out and do things,” said Wunderlin, 42. “It feels like I pulled myself out of that depression.”
His story might sound like the perfect poster case for proponents of Medicaid work requirements—policies that Republicans in Congress and several states, including Ohio, Iowa, and Montana, are pushing to implement. They argue that requiring nondisabled adults to work or engage in job-related activities will encourage self-sufficiency and reduce reliance on public programs.
But Wunderlin’s success is the exception, not the rule.
While his Medicaid plan happened to offer job assistance, most do not. And even where such support exists, access is limited. In fact, nearly two-thirds of adult Medicaid enrollees are already working, and many of the rest are full-time caregivers, students, or living with physical or mental health challenges that prevent steady employment, according to data from KFF Health News.
“Some people argue that there’s a lot of freeloading in Medicaid,” said Ben Sommers, a professor of health economics at Harvard T.H. Chan School of Public Health. “But the evidence just doesn’t support that.”
A Mandate Without a Safety Net
The idea of tying Medicaid to employment has long sparked debate. Under the Trump administration, 13 states received approval to impose work requirements—but nearly all of them were struck down by federal courts or reversed under the Biden administration, except for Georgia’s program.
Critics warn that these requirements are less about helping people get jobs and more about removing them from coverage. Arkansas implemented a work requirement in 2018, and within a year, more than 18,000 people lost coverage—not because they weren’t working, but largely because they didn’t understand the complex reporting rules.
Josh Archambault, a senior fellow at the conservative Cicero Institute, believes states haven’t had enough room to experiment. “I don’t think we’ve given states a fair chance to figure out what works,” he said.
Still, most experts say that simply requiring people to work isn’t enough—it’s the support structure that matters.
From Stick to Ladder: Programs That Actually Help
Some state Medicaid programs and health plans have started investing in employment services that go beyond mandates. CareSource, for example, runs a program called JobConnect, which matches enrollees with life coaches who offer guidance on everything from how to dress for interviews to crafting a résumé. Since 2023, the program has helped about 800 people find jobs. The company itself has hired 29 Medicaid enrollees into full-time roles with benefits in customer service, pharmacy, and other departments.
“Work requirements alone don’t move people into stability,” said Farah Khan, a fellow at the Brookings Institution. “Economic mobility needs a ladder, not a stick.”
Other states are experimenting, too. California’s Medicaid program began offering nontraditional benefits in 2022—including housing support, mental health services, and job assistance—for enrollees facing homelessness or serious mental illness. Nearly 280,000 people have received support so far, though the state doesn’t yet track how many found jobs.
In Pennsylvania, the University of Pittsburgh Medical Center (UPMC), which operates both a major hospital network and a Medicaid plan, has hired over 10,000 of its Medicaid enrollees since 2021. Through its Pathways to Work program, former low-wage workers have transitioned into roles as warehouse staff, call center agents, and medical assistants—many now earning full-time pay with benefits.
“Our program shows what’s possible when healthcare and employment support intersect,” said Dan LaVallee, senior director at UPMC’s Center for Social Impact.
The Risks of Misguided Policy
Meanwhile, some state-level efforts have struggled. In Montana, lawmakers once touted a promising program that paired 32,000 Medicaid enrollees with existing job training services. But when legislators required the program to be outsourced to private contractors, it collapsed. Participation dropped to just 11 people by 2024.
“There wasn’t a real component to offer direct support to the individuals,” said Sarah Swanson, who now leads Montana’s Department of Labor. The state is now trying to revive the effort by letting public agencies work directly with enrollees again.
Back in Ohio, state Medicaid spokesperson Stephanie O’Grady noted that health plans aren’t employment agencies and don’t track job outcomes. But job support may be the missing link for many enrollees still teetering on the edge of poverty.
As the GOP eyes significant Medicaid cuts and more stringent eligibility rules, the conversation about work requirements remains front and center. Yet for every Eric Wunderlin, there are thousands more who are willing to work—but lack the support, training, or health to do so.
And until the system shifts from punishment to empowerment, stories like his will continue to be the exception.