Despite years of failed attempts, mounting evidence of harm, and widespread opposition from researchers and experts, state lawmakers are once again pushing Medicaid work requirements. This time, they’re proposing new methods, including data matching and revised reporting requirements as a way to disguise the same old agenda: making it harder for people to keep their health care.

The 2025 State-Level Attack on Medicaid 

Across the country, state lawmakers are reviving work requirements under new frameworks designed to sidestep past administrative and legal challenges.  While the language may be different, the goal remains the same: create bureaucratic barriers that strip Medicaid coverage from people who qualify. 

In Ohio, a proposed waiver targets Medicaid expansion recipients, requiring 80 hours of work, school, or training per month. Instead of monthly reporting, the state would rely on data matching to determine eligibility and compliance. If work requirements go forward, at least 61,000 people could be disenrolled according to the Ohio Department of Medicaid. State experts think this is a major undercount with an independent study estimating that as many as 450,000 Ohioans could lose their Medicaid coverage.

Between 61,000 and 450,000 people in Ohio could lose their health coverage if a Medicaid work requirement waiver goes into effect.

In Arkansas, a waiver amendment introduces a so-called “Success Coaching” program, forcing enrollees to engage with third-party case managers who track economic and health outcomes. Those who don’t meet state-defined progress markers, or refuse to comply could see their benefits paused, a penalty that functions just like termination. If passed, this waiver is expected to cause major confusion for enrollees with early estimates of at least 25% of enrollees at risk of their coverage being suspended.

In Georgia, the state is doubling down on its existing Pathways to Coverage program, which already imposes harsh work requirements and has been plagued with problems with only about 6,500 people enrolled. A new waiver renewal proposal shifts monthly reporting burdens to annual reporting requiring individuals to maintain a year’s worth of detailed documentation to prove eligibility – another administrative hurdle designed to push people out of the program. If passed, this proposal will also lead to additional confusion for enrollees and could contribute to an increased processing and eligibility backlog for already overwhelmed state caseworkers.

And these are just a few examples. States like Idaho, Montana, South Carolina, Arizona, Missouri, Iowa, and South Dakota are all exploring similar tactics to impose new Medicaid restrictions. 

Data Matching:  Flawed Systems That Could Deny Coverage 

One of the most alarming trends in 2025 is a bait and switch aimed at replacing long standing issues with monthly reporting requirements with data matching – systems that aim to verify employment, income, or compliance automatically. 
 

In reality, data matching is deeply flawed. State databases are costly and often poorly maintained leading to outdated, incomplete, or simply incorrect information. People who should qualify for Medicaid could lose access to care because of: 
 

  • Administrative errors – Small discrepancies between existing systems could trigger a loss of coverage, even when people meet the requirements.
  • Limited exemptions – Many proposals fail to account for caregivers, people with fluctuating work hours, or those with chronic illnesses.
  • Lack of transparency – Enrollees may not even realize their coverage has been cut until they attempt to access care.

This shift allows states to claim they are streamlining the system while actively making it more difficult for people to stay enrolled. 

New Strategy, Same Harm 

At its core, this latest push for work requirements isn’t about helping people find jobs – it’s about making it harder for families to keep their health care. The majority of adults on Medicaid are already working—nearly two-thirds of Medicaid enrollees under 65— or face barriers that prevent them from maintaining stable employment.These policies don’t create economic opportunity; they create red tape that disproportionately harms families with low-incomes, people with disabilities, and other communities already struggling to make ends meet.

The fight to protect Medicaid is far from over. With a long battle ahead, we must continue exposing these policies for what they really are: an effort to cut Medicaid by ripping away health care from those who need it most. 

Watch our explainer video to learn more about why work requirements fail—and what we can do instead to build a fairer, healthier health system for all. 

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