Chris Medrano and Brian Blase write for the Federalist about the importance of enforcing Medicaid work requirements.
In the Working Families Tax Cut Act — also known as the One Big Beautiful Bill — Congress required able-bodied, working-age adults to work, volunteer, or participate in job training to receive Medicaid unless they qualify for an exemption. More than 80 percent of Americans support such requirements.
The work requirements are more important because of Obamacare. The federal government pays states roughly seven times more for able-bodied, working-age adults on the program per state dollar than it does for traditional Medicaid enrollees — such as children, pregnant women, seniors, and individuals with disabilities. To protect the most vulnerable, the federal government must put guardrails on spending for expansion enrollees.
The work requirements do not apply to people with disabilities, parents with young dependents, or those deemed “medically frail.” Crucially, work is essential for upward mobility and a more stable life.
Unfortunately, some states are gearing up to permit applicants (or intermediaries enrolling them on their behalf) to self-attest to meeting the requirements or qualifying for an exemption. These states would permit applicants to simply check a box without verification.
Failing to verify applicant information has led to widespread improper enrollment and fraud in other programs. The massive improper enrollment in the Affordable Care Act (ACA) proves that when the government weakens verification standards, including through self-attestation, improper enrollment rises dramatically.
In 2024, the Biden administration loosened eligibility verification for heavily subsidized ACA plans and expanded reliance on applicant self-attestation. Previously, applicants whose income could not be verified generally had to submit documentation before receiving subsidized coverage. Beginning in 2024, exchanges were required to accept self-attestation when income could not be verified through tax data.
This decision had predictably harmful consequences, especially when combined with expanded ACA subsidies that fully subsidized plans for individuals claiming low incomes.
