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President Donald Trump responded to his criticism of his “big, beautiful bill” when Musk answered with X.
The heart of Donald Trump’s tax bill will allow millions of Medicaid recipients to work and volunteer or study to maintain publicly funded health insurance.
Republicans say they are motivating non-disabled Medicaid recipients to be in charge of physical and financial health while protecting taxpayers. Dr. Mehmet Oz challenged the group to “prove that you matter.”
However, health advocacy groups and analysts say that most recipients are already working in jobs that don’t offer affordable health insurance or paying enough to those who can afford their own insurance. They say that Medicaid job requirements — combined with more frequent eligibility checks — will create a management nightmare that removes coverage for many people eligible for public health insurance programs for low-income and disabled residents.
What is Medicaid churn?
Medicaid rolls vary from month to month as people lose eligibility due to new jobs, salary increases or other sources of income that have been inappropriately disqualified due to compensation. Unemployment or a change in living circumstances can make someone new and qualify.
The constant change in Medicaid Roll is what health policy experts call churn. Anyone who temporarily loses compensation due to a document issue or mistake must sign up again.
“What happens when these qualifying systems become more difficult to navigate,” said Jennifer Tolbert, associate director of the Medicaid program and an uninsured person with KFF, a health policy nonprofit.
The federal government requires that state Medicaid programs check the eligibility of enrollees once a year. Trump’s tax cuts law requires states to double eligibility checks twice a year. And the state will have an additional obligation to verify a person’s employment or exemption status.
The law that passed the House and awaits Senate approval requires Medicaid recipients “Healthy” Adults without children either work 80 hours a month or are eligible for exemptions for students, caregivers, disability, and more. The bill is defined as people who are not medically recognized as physical or unemployed. The law would also strip the reporting of undocumented immigrants who obtain Medicaid through a state-funded program.
Health policy experts say more frequent eligibility checks and deficits add management costs and cut off people who are eligible but have crossed the rift due to mismanagement.
“People need to document their work status or exemption status multiple times a year. At each point there is a risk that a qualified person may lose compensation,” Tolbert said.
Thousands of people lost coverage under Arkansas’ work requirements
During the first Trump administration, the Centers for Medicare and Medicaid Services offered the state the option to implement work requirements for non-disabled adults in Medicaid. Arkansas’ labor requirements cut more than 18,000 residents from Medicaid within the first seven months of the program. People were frequently deleted because people were unaware of the documentary requirements to maintain coverage, according to research shows and analysts.
In April, a study by researchers from the Urban Research Institute and Loyola University Chicago found that Arkansas’ uninsured interest rates jumped 7.4 percentage points among low-income adults aged 30 to 49 after the state’s labor requirements began. The impact of policy on employment among those age groups was “negative, small and statistically insignificant,” the study said.
This policy disproportionately hurts Arkansas adults who were unable to access the internet at home. This could have been a struggle for adults to access the state’s online portal and report work history or exemptions, the Urban Institute said.
If work requirements for Medicaid recipients are adopted nationwide, health experts say millions of working poor Americans will inevitably lose compensation.
The Non-Participation Congressional Budget Office estimates that 10.9 million Americans will lose health insurance coverage under the law throughout 2034. KFF analysis shows that while most people lose coverage due to Medicaid job requirements and twice-eligible qualification checks per year, around 3.1 million people are uninsured, from fine-tuning to Affordable Care Act registration.
Without extending the tax credits during the Covid-19 pandemic era, which made the ACA plan more affordable for consumers, the uninsured rank could grow. According to the CBO, as many as 16 million Americans would lose compensation if the tax credit expires and Congress passes the current version of the Trump tax bill.
“We’re excited to be a part of our policy,” said Kathy Hempstead, senior policy officer at the Robert Wood Johnson Foundation. “But we expect it to be very big as people are unable to comply with the requirements and lose compensation.”
Dr. Oz: Medicaid spending “crippling the system”
The Trump administration’s largest Medicaid official has defended the House Act as a necessary step to slow down spending on federal health programs that cover nearly 80 million low-income and Americans with disabilities.
In a June 4 interview with Fox Business, Dr. Oz challenged Medicaid recipients facing work requirements to “prove that you matter.”
Oz, a Trump-appointed administrator at the Centers for Medicare and Medicaid Services, said the work requirements were “at least healthy individuals who can return to work can take care of their loved ones who get a job, volunteer, need help, or return to school.”
In an interview with FOX News posted on social media site X, OZ said Medicaid spending has skyrocketed 50% since 2019, at a pace that “crippled the system.”
However, some Republicans have pushed back the proposed cuts. In a May opinion in the New York Times, Sen. R-Missouri, Sen. Josh Hawley, said he would “cut off health insurance for the poor working people.”
Research: Americans are worried about Medicaid reduction
The public is paying attention to the proposed Medicaid reduction. More than half of adults said they were worried that a significant cut in Medicaid spending could negatively affect families’ ability to obtain health care, according to a KFF health follow-up survey released on June 6.
Nearly six in 10 adults said Trump administration’s policies would weaken Medicaid, but there were severe disparities based on party affiliation. There are nine in 10 Democrats, but only two in 10 Republicans expect administration policies to weaken Medicaid. Republicans are also far more likely to say that Trump’s policies will strengthen Medicaid than Democrats.
Still, research suggests that people are tracking the news, but many people probably don’t know if their compensation has changed until they get medical care.
“People don’t know much about losing coverage until they tried to fill their prescriptions or even see a doctor,” Tolbert said.
