Developed Michigan's Medicaid work prerequisite system; now issues caution to other states.

Michigan's implementation of Medicaid work requirements, a policy aimed at states that expanded Medicaid coverage to more working-age adults, commenced on January 1, 2020. Enrollees in these states were required to prove they were working, volunteering, getting job training, or participating in other qualifying activities for at least 80 hours a month to maintain their coverage.

However, the policy faced a significant hurdle when a federal judge issued a ruling on March 4, 2020, blocking Michigan's work requirement policies from going forward. This decision came only days before Michigan announced its first cases of COVID-19.

The ruling was a relief for the estimated 80,000 Michiganders who were on track to lose their Medicaid coverage due to non-compliance with the work requirements. By March, around 80,000 of those had failed to report their activities, but their health coverage continued as the pandemic unfolded.

The state had determined that the vast majority of the nearly 700,000 Medicaid expansion recipients already met the work requirement or were exempt. Nevertheless, about 100,000 people's status was unknown and had to go through the reporting process.

The work requirement rules for Medicaid in the 40 states and Washington, D.C. that have expanded Medicaid are set to begin on January 1, 2024. By 2027, these enrollees will need to comply with the work requirements or risk losing their coverage.

The new tax-and-spending law signed by President Donald Trump in July 2025 mandates a vast expansion of Medicaid work requirements to these 40 states and Washington, D.C. Fiscal hawks were concerned about the increasing share of health care costs that the state was responsible for, and the work requirements were seen as a way to address this concern.

However, the policy has been met with criticism from Democrats, who argue that it's political cover for slashing the program. Republicans, on the other hand, argue that the work requirements are a commonsense way to weed out "freeloaders."

The expansion of Michigan's Medicaid program, which was signed into law in 2013, was a success from a coverage perspective, with nearly 700,000 new Medicaid recipients by 2019. However, the implementation of the work requirements cost the state $30 million.

As the work requirement policies continue to evolve, the number of people who lose coverage could vary widely by state, depending on how each state implements and maintains its reporting system. The impact of these policies on the health and well-being of millions of Americans remains a topic of ongoing debate and concern.