New Medicaid work rules risk coverage losses for many older adults.
New Medicaid work rules set to take effect next year are expected to affect millions of low-income adults, with middle-aged Americans likely facing the greatest strain. While supporters frame the policy as a way to promote employment and reduce costs, health policy experts and researchers warn the rules may instead push many people out of coverage, even when they are already working, caregiving, or struggling with health problems.
For people like Lori Kelley, health coverage through Medicaid has been the difference between managing chronic illness and going without care. Kelley, 59, lives in North Carolina and earns less than $10,000 a year. Vision loss forced her to shut down a small nonprofit she once ran, and her work options are limited. She currently sorts recyclables at a local venue, a job that provides income only part of the year. Medicaid covers her medications for arthritis, anxiety, and high blood pressure, and pays for doctor visits she could not otherwise afford. Under the new rules, she worries that her irregular work hours could put her coverage at risk.
Starting in January, adults in most states will be required to work, volunteer, attend school, or take part in approved activities for at least 80 hours each month to qualify for or keep Medicaid. About 20 million people across 42 states and Washington, D.C., will fall under the new requirements. States that did not expand Medicaid under the Affordable Care Act will not be required to enforce the rules, leaving residents in those states unaffected by this specific change.
Lawmakers backing the policy have argued that Medicaid was never meant to cover people who could work but choose not to. Public statements have often focused on younger adults as the supposed target. Data, however, paints a different picture. Adults between the ages of 50 and 64 make up a large share of Medicaid enrollees, and many already face health limits, unstable work, or caregiving duties. Women in this age group are especially vulnerable, according to health researchers.
Medicaid currently covers about one in five Americans between 50 and 64, offering a bridge to Medicare eligibility at age 65. Many in this group develop serious health issues well before that milestone. Arthritis, heart disease, vision loss, diabetes, and mental health conditions become more common with age, often making steady work difficult. At the same time, many middle-aged adults step away from paid jobs to care for aging parents, spouses with disabilities, or grandchildren.
Research shows that only a small share of Medicaid recipients fit the description of being able to work and not doing so. Studies estimate that roughly 8% of enrollees fall into that category, and many of them are women who left the workforce to provide unpaid care at home. Among this group, about one in four are age 50 or older. These findings challenge the idea that Medicaid is widely used by people avoiding work.
The Congressional Budget Office estimates that the work rules will lead to at least five million people losing Medicaid coverage over the next decade. Critics argue the policy is a cost-cutting measure that shifts financial risk onto people with limited resources. They also warn that losing health coverage may make it harder for people to work, not easier. Untreated health problems can worsen, leading to missed work, job loss, and higher long-term medical costs.
Federal officials say safeguards are in place. Exemptions are supposed to apply to people with disabilities, full-time caregivers, pregnant and postpartum individuals, veterans with serious disabilities, and others facing hardship. Yet past experience in states that tested similar programs suggests many eligible people still lost coverage due to paperwork problems, reporting errors, or confusion about the rules. Complex systems and unclear guidance often created barriers even for those who should have qualified for exemptions.
Caregiver advocates are particularly concerned. Many adults in their 50s and early 60s belong to what is often called the sandwich generation, caring for both older relatives and younger family members. While the law allows some caregivers to be exempt, advocates say the definitions are narrow and may leave many people unprotected. Without coverage, caregivers may skip their own medical care, leading to declining health and family crises.
Health policy experts also warn of downstream effects. Adults who lose coverage before age 65 may enter Medicare with more advanced illnesses, raising costs for the program later. What appears to save money in the short term could increase spending down the road, while placing strain on families and healthcare systems in the meantime.
As the rollout approaches, uncertainty remains high. For many middle-aged adults living on the edge of financial and physical stability, the new Medicaid work rules represent not a push toward opportunity, but a threat to basic healthcare access.
Sources:
New Medicaid work rules likely to hit middle-aged adults hard
New Medicaid, SNAP work requirements may delay retirement for older workers
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