Debates over Medicaid policy are intensifying across the country, with rhetoric often running far ahead of reality. In Michigan, that’s playing out in real time — with alarming claims and overblown numbers drowning out thoughtful discussion.
Rather than give in to fear-based talking points, we need to get back to basics: Medicaid is meant to be a safety net, not a substitute for self-sufficiency. Work and community engagement requirements for able-bodied adults are one tool to keep that promise.
A widely circulated quote, citing numbers from the Michigan Department of Health and Human Services, warns that “Republican cuts will strip away healthcare for 730,435 Michiganders in Wayne County.” That figure is mathematically impossible — and dangerously misleading.
Michigan’s total Medicaid enrollment is approximately 1.9 million. Wayne County accounts for only about 518,000 of those enrollees.
So how can 730,435 people in just one county lose coverage? They can’t — because the number exceeds the actual Medicaid population in Wayne County by more than 40%.
At best, it’s possible this figure represents a cumulative 10-year estimate (a common window for budget forecasts) of reduced enrollment due to shrinking caseloads — perhaps assuming a 14% drop in total enrollment over a decade. But if that’s the case, let’s be honest about what the number means: This is not 730,000 people being kicked off the rolls tomorrow. It’s a projection based on enrollment trends, not a sudden act of cancelling coverage.
This sloppy approach, playing fast and loose with the numbers, stoking fear instead of fostering understanding. And it distracts from the modest, reasonable changes that are on the table.
The uproar is rooted largely in opposition to new “work” requirements — though that term, too, is often misunderstood.
It applies only to able-bodied adults without dependents under age 13 (in the Senate version, which is stricter than House version). It does not apply to seniors, pregnant women, people with disabilities, or caregivers.
It requires just 20 hours per week of qualifying activity. Qualifying activities include employment, job training, education, substance use treatment and even volunteering. The requirement includes broad exemptions for hardship, illness, caregiving responsibilities, or living in areas with limited job opportunities.
This is not some draconian mandate. It’s a basic engagement requirement that asks those who can participate to take small, steady steps toward greater independence. This requirement reflects the same expectations already in place for cash welfare assistance. In many ways, it reflects the expectations working Americans already face — often while paying the taxes that support the program.
Work requirements for able-bodied adults aren’t about cruelty or cuts. They’re about rebuilding the link between public support and personal agency.
It’s time to leave behind inflated numbers and fear-driven narratives. Medicaid work requirements — modest, flexible and fair — represent a balanced approach that protects the vulnerable while helping able-bodied adults chart a path toward independence.
Michigan deserves a Medicaid system that uplifts, empowers, and respects both recipients and taxpayers. That conversation starts with facts, not fiction.
