INTRODUCTION

Medicaid is the “primary program” that provides health insurance coverage and long-term care to low-income people in the United States (Kaiser Family Foundation). With annual expenses of nearly $900 billion, Medicaid serves 80 million people and represents one-fifth of health care spending nationwide. Recently, in the One Big Beautiful Bill Act of 2025, Congress mandated new work requirements for current Medicaid recipients and any new applicants to the program (McDermott+). Beginning in 2027, all Medicaid recipients aged 19 to 64 without dependents must demonstrate at least 80 hours of “work, community service, or participation in a work program,” a monthly income equivalent to 80 hours of work, or part-time enrollment in an educational program. Several major exemptions do exist, including for those who are pregnant or medically frail.

Proponents of the new work requirements argue that such expectations promote self-sufficiency among Medicaid recipients and that they cut down on waste, fraud, and abuse. They note that there is widespread public support for the measures and that they are not without precedent, as similar changes were included in the welfare reforms of 1996 and during the first Trump administration (Centre for Public Impact). Additionally, supporters highlight the flexibility that individual states have in the administration of the new rules. Opponents of the work requirements express concerns that the mandate will negatively impact those who are disabled, elderly, or who are serving as the primary caretakers of their families. They state that the provision may also preclude individuals from seeking work if they are unable to receive the health care that they need. Additionally, they argue that the requirements place additional burdens on states, resulting in increased bureaucratic costs that exceed any savings gained from lower Medicaid recipient rolls.

So what do you think? This deliberation presents ten video clips, five articles, and numerous educational activities to guide students through a review of the debate over whether there should be work requirements for Medicaid recipients. After a careful review of multiple perspectives, students will determine their answer to the question and be presented with several optional extensions to take an active role in the debate.

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Objectives and Outcomes

• Students will be able to describe key vocabulary terms and concepts associated with the debate surrounding whether there should be work requirements for Medicaid recipients.
  
  
• Students will be able to identify and explain aspects of the debate surrounding whether there should be work requirements for Medicaid recipients, including those arguments related to self-sufficiency, governmental efficiency, and individual health care needs, among others.
  
  
• Students will be able to evaluate arguments related to the debate surrounding whether there should be work requirements for Medicaid recipients and formulate an opinion on this question.

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