DRIVING DISCONNECTION: STRUCTURAL BARRIERS TO MEDICAID WORK REQUIREMENTS FOR BLACK AMERICANS EXECUTIVE SUMMARY
Beginning January 1, 2027, Section 71119 of the One Big Beautiful Bill Act introduces a new national requirement tying Medicaid eligibility not only to income but also to verified participation in at least 80 hours per month of work or qualifying community engagement activities. While framed as a pathway to economic self-sufficiency, this policy overlooks the structural barriers that determine whether low-income adults, especially Black Americans, can realistically meet these obligations. This analysis evaluates how income, unemployment, digital access, and transportation affordability shape the feasibility of meeting this new 80-hour work requirement across five states: Arkansas, Georgia, Nebraska, Pennsylvania, and Texas. Without addressing transportation and digital access, these work requirements will serve as a coverage filter rather than a workforce strategy.
Key Findings
Coverage losses, not employment gains, are the most likely outcome: Past implementations in Arkansas and Georgia led to significant coverage losses, no measurable increase in employment, and high administrative costs (over $40 million in Georgia), indicating that the new national requirement is likely to replicate these patterns unless transportation, wage, and digital barriers are addressed. Most adults enrolled in Medicaid are already working or unable to work for valid reasons: In 2023, most adults enrolled in Medicaid under age 65 were working (64%), while the remainder were primarily not working due to caregiving, illness, disability, or school enrollment, with only a small share (8%) not working for other reasons. Among those employed, 69% worked full-time. Compliance failures are therefore not a function of unwillingness to work but of structural barriers to securing and maintaining hours. Minimum wage income from 80 hours of work falls far below the federal poverty line: The federal minimum wage in Georgia, Texas, and Pennsylvania yields just $580 per month, only 44.5% of the Federal Poverty Level (FPL) for a single adult. Even in Nebraska, where higher wages raise monthly earnings to $1,080, workers who reach the 80-hour benchmark earn only 82.8% of the FPL. These poverty-level earnings fall far short of covering essential expenses such as housing, transportation, childcare, and digital access. Digital reporting requirements amplify inequities: Household digital access varies, with rural areas having more prominent access gaps, especially in Arkansas and Nebraska, which have high broadband gaps. Similarly, Texas and Georgia have large numbers of households, over 480,000 in Texas alone, without internet access. Black and Hispanic adults are disproportionately affected. Digital reporting failures were the primary reason 18,000 Arkansas residents lost Medicaid coverage under the previous work requirements. Transportation costs exceed total income under the work requirement: Across all five states, average monthly transportation costs exceed or nearly equal the earnings from 80 hours of work (174–187% of income in Georgia, Texas, and Pennsylvania, 115% of income in Arkansas, and 94% of income in Nebraska). Vehicle ownership costs nearly $12,000 per year, while bus and rail fares require 5–30% of a worker’s monthly income. Yet transit systems in Georgia, Texas, and Arkansas have limited coverage, infrequent service, and long travel times. Black workers experience the longest transit commutes in the country, averaging 52 minutes. Without robust transit, workers face a “mobility penalty” that jeopardizes their Medicaid coverage.