Medicaid Coverage Watch · Research

What the research projects

Official and research estimates of what the requirement could mean, our studies, and the wider literature. Most analyses of the requirement do not look at cancer.

Official and research estimates Our work and related research

Checked 9 October 2026

Estimates

Official and research estimates

5.3 million

more people uninsured in 2034 from the work requirements alone, the largest effect of any Medicaid provision in the law.

Congressional Budget Office 2025 · projection for the enacted law

41%

of at-risk Medicaid adults (not exempt, under 20 work hours a week) had three or more chronic conditions in 2017–2023 survey data; a second study found at-risk adults had more physical and mental limits than those working more.

Chetty et al., JAMA 2025; Vyas et al., Ann Intern Med 2026 (hypothetical nationwide rule) · survey data from before the law

4 in 10

Medicaid adults whose health limits their work reported no treatment in a year for any condition on past state frailty lists, so a 12-month claims check could miss them.

Karpman et al., Urban Institute 2026 · survey analysis, not peer reviewed; a 17-state simulation also found state screens would miss most adults with disabilities (Basu and Berkowitz, Health Aff Sch 2026).

7,049–9,252

projected extra deaths a year from the work requirements alone at full effect (medians of three scenarios; wide uncertainty).

Pandey et al., Lancet Reg Health Am 2025 · journal model of the enacted rule; coverage inputs predate enactment

16,642

projected extra deaths a year from the Medicaid cuts in the May 2025 House bill (mid-range; range 8,241–24,604).

Gaffney et al., Ann Intern Med 2025 · journal model of the House bill, before enactment

42,500+

projected deaths a year from three parts of the House-passed bill: coverage losses, Medicaid losses for low-income Medicare enrollees and the nursing-home staffing rollback.

Penn LDI and Yale, June 2025 · letter to senators, not peer reviewed

Death figures are projections of yearly deaths at full effect, not deaths so far. They cover different provisions and bill versions; do not add them.

Sources

Congressional Budget Office. Supplemental cost estimate: Public Law 119-21, title VII, subtitle B, chapter 1, Medicaid, as enacted on 4 July 2025. 28 October 2025. cbo.gov/publication/61837

Chetty AK, Ross JS, Chen AS. Clinical characteristics of adults at risk of Medicaid disenrollment due to HR 1 work requirements. JAMA. 2025;334(20):1850–1853. doi:10.1001/jama.2025.16533

Vyas DA, Mein SA, Tale AP, Wadhera RK. Functional status of adults at risk of Medicaid disenrollment under national work requirements. Ann Intern Med. 2026;179(5):666–672. doi:10.7326/ANNALS-25-04811

Karpman M, Kenney GM, Haley JM. Stricter rules for medical frailty exemptions from Medicaid work requirements put adults with significant health needs at high risk of losing health care. Urban Institute; 11 August 2026. urban.org

Basu S, Berkowitz SA. Redesigning Medicaid frailty algorithms: improved identification of medically frail adults under community engagement. Health Aff Sch. 2026;4(6):qxag108. doi:10.1093/haschl/qxag108

Pandey A, Ye Y, Bawden C, Singer BH, Galvani AP. Quantifying the mortality and morbidity impact of Medicaid work requirements: a modeling study. Lancet Reg Health Am. 2025;51:101232. doi:10.1016/j.lana.2025.101232

Gaffney A, Himmelstein DU, Woolhandler S. Projected effects of proposed cuts in federal Medicaid expenditures on Medicaid enrollment, uninsurance, health care, and health. Ann Intern Med. 2025;178(9):1334–1342. doi:10.7326/ANNALS-25-00716

Werner RM, Coe NB, Roberts ET, Galvani A, Pandey A, Ye Y. Projected mortality impacts of the budget reconciliation bill. Letter to Sens. Ron Wyden and Bernie Sanders. Penn Leonard Davis Institute of Health Economics; 3 June 2025. ldi.upenn.edu

Studies

Most analyses of the requirement do not look at cancer.

Our studies, and the wider literature.

Our work

Title	Venue	Status

Related research

Study	What it examined	Finding	Cancer