How do Medicaid work requirements impact adults with disabilities and pregnant people?

1. Bold claim: Work requirements remove coverage, not jobs

Analysts and state experiences converge on a central claim: work requirements primarily cause coverage loss rather than improve employment. Multiple reports documenting Arkansas’ 2018 rollout show more than 18,000 people lost coverage in seven months largely due to reporting failures and complex systems, not improved labor market attachment ^{[1] [4]}. National briefs reiterate that most Medicaid adults already work or have valid exemptions, so mandatory reporting mainly creates bureaucratic failure points where people drop off coverage rolls. The evidence emphasizes administrative churn—missed deadlines, confusing portals, and poorly publicized exemptions—as the mechanism driving coverage loss rather than changes in employment behavior ^{[2] [4]}.

2. Why adults with disabilities are especially vulnerable

Experts highlight that people with disabilities face structural barriers to meeting work mandates and navigating exemptions, increasing their likelihood of losing coverage. Reports note that exemptions for disability are often ineffective in practice, requiring documentation that beneficiaries struggle to obtain or submit, thereby converting intended protections into additional hurdles ^{[2] [4]}. Beyond paperwork, many adults with disabilities contend with episodic health needs, transportation limits, and jobs with irregular schedules that complicate hour-tracking. The evidence indicates these policies can push people off coverage even when they qualify for exemptions, worsening health outcomes and financial insecurity rather than promoting stable employment ^{[2] [4]}.

3. Pregnancy and maternal health: administrative rules risk lives

Analyses of maternal coverage show that pregnant people are at elevated risk from administrative disruptions, especially in states with limited maternity safety nets. Medicaid covers a large share of births and provides prenatal and postpartum care critical to maternal and infant outcomes; while pregnancy-based exemptions exist on paper, the requirement to document or re-verify status introduces gaps that can force people to miss care during pregnancy or after childbirth ^{[5] [6]}. Observers warn that even short coverage interruptions can worsen prenatal care continuity, increase uncompensated care burdens for providers, and deepen rural maternal health shortages, making the nominal exemption insufficient protection without robust implementation ^[5].

4. The policy landscape: federal law, waivers, and projected impacts

Federal changes now require states to impose work conditions on Medicaid expansion adults by early 2027, setting 80 hours of qualifying activities per month and projecting millions of coverage losses over a decade ^{[3] [7]}. States may also seek waivers for other populations, and CMS has been shifting guidance on demonstration authority, creating uncertainty about enforcement and exemptions ^[8]. The Congressional Budget Office estimates that about 4.8 million people could lose Medicaid over ten years under these rules, a projection that underscores the scale of potential disruption and the likely disproportionate effect on disabled and pregnant beneficiaries despite stated exemptions ^[3].

5. Competing narratives and what’s missing from the evidence

Proponents argue work requirements encourage labor force participation, but empirical state-level evaluations fail to show employment gains and instead document coverage churn, which weakens the pro-work argument ^{[1] [4]}. Critics emphasize health and equity harms, particularly for people of color, rural residents, and those with disabilities or caregiving responsibilities; these groups face higher administrative friction and are less likely to gain from nominal job mandates ^{[2] [6]}. Notably, existing analyses focus on short-term coverage loss and administrative failures—longer-term labor market, health outcome, and fiscal impacts remain less well measured, leaving key empirical gaps in causal pathways and cost-offset claims ^{[4] [3]}.

6. Bottom line: policy design determines outcomes, but current evidence warns of harm

Cross-source analysis shows that design and implementation—outreach, simple exemptions, and easy reporting—determine whether work policies harm or spare vulnerable people, yet past rollouts have not met that bar and led to substantial coverage losses ^{[1] [2]}. The mixture of federal mandates, waiver activity, and documented state failures indicates a clear risk that adults with disabilities and pregnant people will experience greater administrative dislocation and health harm than any measurable employment benefit. Policymakers seeking workforce goals must reconcile these documented harms with robust safeguards, simplified processes, and independent monitoring to prevent predictable coverage shocks ^{[4] [7]}.