As many as 109,000 Marylanders could get thrown off Medicaid if Congress follows through on a proposal to impose a work requirement for the coverage, according to a new report.
The report from the Robert Wood Johnson Foundation comes as some lawmakers are looking for ways to cut billions in federal spending in coming years. One proposal, to require that able-bodied adults work at least 2o hours a week to receive the benefits, would trim an estimated 7% of recipients — 109,000 people in Maryland, and about 5 million nationwide, the report estimates.
“That would be a significant amount of coverage lost,” said Katherine Hempstead, senior policy officer for Robert Wood Johnson Foundation. “And it would have really hard consequences for people who would lose their coverage.”
The study based its estimates on work requirement language in a 2023 bill, the Limit, Save, Grow Act, which would have required Medicaid recipients to work at least 80 hours a month unless they were exempt as a student, a family caregiver or because of a disability.
The report comes as House Republicans and the Trump administration l0ok to cut billions in federal spending over the next decade. The budget resolution recently adopted by the U.S. House of Representatives directs the House Energy and Commerce Committee, which oversees Medicaid, to cut $880 billion over 10 years.
Such reductions would likely require cuts to Medicaid, the joint federal-state health care plan for low-income residents – but exactly how those cuts would be implemented is yet to be decided. Work requirements is one of the options on the table, along with other measures to cut spending to Medicaid.
“There is this quest to find some budget cuts … Work requirements is one of the options that seems to gathering a little bit broader support than some of the others,” Hempstead said. She believes it’s important to know how work requirements could impact health care coverage, even if Congress decides not to add work requirements.
Proponents of work requirements say the policy would help move people into the workforce and help save taxpayer dollars.
The Foundation for Government Accountability, a conservative think-tank, said that work requirements “move millions of able-bodied adults from welfare to work,” in a post earlier this week.
“This, in turn, would save taxpayers billions of dollars, preserve resources for the truly needy, and put the Medicare and Social Security trust funds on more solid ground,” the foundation said.
House Speaker Mike Johnson (R-La.) said in a February interview with CNN that the work requirements would not “cut benefits for people who rightly deserve” them.
“You don’t want able-bodied workers on a program that is intended, for example, for single mothers with two small children who is just trying to make it,” he said. “That’s what Medicaid is for – not for 29-year-old males sitting on their couches playing video games. We’re going to find those guys and were going to send them back to work.”
But opponents of work requirements say that those policies do not reflect the challenges of finding work and proving eligibility to federal officials in order to keep coverage through Medicaid.
The report focused on states that have opted to increase Medicaid coverage through the Affordable Care Act expansion, which allows participating states to provide coverage for households that earn up to 138% of the federal poverty level income. Maryland is one of the 40 expansion states.
The report estimates that some 5 million people who live in those states could lose health care coverage if Congress imposes a work requirement to qualify for Medicaid. That would equate to about 6.9% of all 72 million people on Medicaid across the United States.
For Maryland, a work requirement could result in between 95,000 to 109,000 people losing coverage out of 1.5 million currently enrolled in Medicaid, according to the report.
The state with the largest raw number of people who could lose coverage would be California, with between 1 million to 1.2 million people affected out of the total 14 million current Medicaid recipients in the state. On the other end, between 5,000 and 6,000 of North Dakota’s 104,000 Medicaid recipients could lose coverage due to work requirements, according to the RWJF estimates.
But Hempstead also fears that work requirements will ultimately kick people off Medicaid who may still qualify for it. She said that people can often get caught up in the bureaucratic paperwork, which can be taxing for people who rely on Medicaid, as people have to prove whether they have work, are looking for work, or have a reason why they can’t work.
“Even if you accept the idea that people should have to work to get their health insurance,” she said, “what happens with work requirements is a lot of people lose coverage that are working — or are caregiving or are doing other things — and shouldn’t lose their coverage.”
Meanwhile, Hempstead noted the those who lose coverage due to work requirements would strain hospital systems, as uninsured people seek health care through other means, such as the emergency room or through charity care. That could exacerbate Maryland’s lengthy emergency room wait times, which are already some of the highest in the nation.
“There is a lot of spill-over into the health care system. As the uninsurance rate goes up and people don’t have health insurance, they try to ignore things and try to not get care. And sometimes things go away on their own and sometimes they don’t,” she said. “When things are really, really bad, they’ll go to the emergency room, where people will know that they will get treated.”
Benjamin Orr, executive director for Maryland Center on Economic Policy, said that work requirements are counterproductive and will take health insurance away from people who need it, regardless of employment.
“Our society does better when its members are healthy,” Orr said “The idea that we’re going to deny health coverage to 100,000 Marylanders or more is counterproductive to a healthy prosperous society.”
Orr also added that with talks of a looming recession, people are going to have a hard time finding jobs to fulfill work requirements to maintain health coverage. He noted that Maryland “is particularly susceptible to” layoffs in the federal government and other major institutions impacted by decisions from the Trump administration.
“It’s not a good time to be looking for a job, as we are on the cusp of a state-level recession, if not a national recession,” Orr said. “Even folks who might, otherwise in a healthy economy, be well positioned to find work may struggle to find work.”
Hempstead agrees that the work requirement logic is “backwards.”
“When people are healthy, they can work more,” she said. “It’s kind of a bad theory that you ought to be able to work in order to earn access to health care.”
by Danielle J. Brown, Maryland Matters
April 18, 2025
Maryland Matters is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Maryland Matters maintains editorial independence. Contact Editor Steve Crane for questions: [email protected].
