DRIVINGDISCONNECTION:STRUCTURALBARRIERSTO MEDICAIDWORKREQUIREMENTSFORBLACKAMERICANS
EXECUTIVESUMMARY
BeginningJanuary1,2027,Section71119oftheOneBigBeautifulBillActintroducesanew nationalrequirementtyingMedicaideligibilitynotonlytoincomebutalsotoverified participationinatleast80hourspermonthofworkorqualifyingcommunityengagement activities.Whileframedasapathwaytoeconomicself-sufficiency,thispolicyoverlooks thestructuralbarriersthatdeterminewhetherlow-incomeadults,especiallyBlack Americans,canrealisticallymeettheseobligations.Thisanalysisevaluateshowincome, unemployment,digitalaccess,andtransportationaffordabilityshapethefeasibilityof meetingthisnew80-hourworkrequirementacrossfivestates:Arkansas,Georgia, Nebraska,Pennsylvania,andTexas.Withoutaddressingtransportationanddigital access,theseworkrequirementswillserveasacoveragefilterratherthanaworkforce strategy.
KeyFindings
Coveragelosses,notemploymentgains,arethemostlikelyoutcome:Past implementationsinArkansasandGeorgialedtosignificantcoveragelosses,no measurableincreaseinemployment,andhighadministrativecosts(over$40millionin Georgia),indicatingthatthenewnationalrequirementislikelytoreplicatethesepatterns unlesstransportation,wage,anddigitalbarriersareaddressed.
MostadultsenrolledinMedicaidarealreadyworkingorunabletoworkforvalid reasons:In2023,mostadultsenrolledinMedicaidunderage65wereworking(64%), whiletheremainderwereprimarilynotworkingduetocaregiving,illness,disability,or schoolenrollment,withonlyasmallshare(8%)notworkingforotherreasons.Among thoseemployed,69%workedfull-time.Compliancefailuresarethereforenotafunction ofunwillingnesstoworkbutofstructuralbarrierstosecuringandmaintaininghours.
Minimumwageincomefrom80hoursofworkfallsfarbelowthefederalpovertyline: ThefederalminimumwageinGeorgia,Texas,andPennsylvaniayieldsjust$580per month,only44.5%oftheFederalPovertyLevel(FPL)forasingleadult.EveninNebraska, wherehigherwagesraisemonthlyearningsto$1,080,workerswhoreachthe80-hour benchmarkearnonly82.8%oftheFPL.Thesepoverty-levelearningsfallfarshortof coveringessentialexpensessuchashousing,transportation,childcare,anddigital access.
Digitalreportingrequirementsamplifyinequities:Householddigitalaccessvaries,with ruralareashavingmoreprominentaccessgaps,especiallyinArkansasandNebraska, whichhavehighbroadbandgaps.Similarly,TexasandGeorgiahavelargenumbersof households,over480,000inTexasalone,withoutinternetaccess.BlackandHispanic adultsaredisproportionatelyaffected.Digitalreportingfailuresweretheprimaryreason 18,000ArkansasresidentslostMedicaidcoverageunderthepreviousworkrequirements.
Transportationcostsexceedtotalincomeundertheworkrequirement:Acrossallfive states,averagemonthlytransportationcostsexceedornearlyequaltheearningsfrom 80hoursofwork(174–187%ofincomeinGeorgia,Texas,andPennsylvania,115%ofincome inArkansas,and94%ofincomeinNebraska).Vehicleownershipcostsnearly$12,000per year,whilebusandrailfaresrequire5–30%ofaworker’smonthlyincome.Yettransit systemsinGeorgia,Texas,andArkansashavelimitedcoverage,infrequentservice,and longtraveltimes.Blackworkersexperiencethelongesttransitcommutesinthecountry, averaging52minutes.Withoutrobusttransit,workersfacea“mobilitypenalty”that jeopardizestheirMedicaidcoverage.