Funding for Social Security, Medicaid, and Medicare accounted for 41 percent of federal spending in FY 2024. The One Big Beautiful Bill Act, which is expected to add $3.9 trillion to the federal deficit over the next 10 years, aims to rein in some entitlement spending by implementing work requirements for Medicaid recipients. However, these provisions could backfire by increasing administrative burdens and making the program less efficient.
Currently, the bill would require beneficiaries aged 19–64 who apply for Medicaid or who are enrolled through the Affordable Care Act expansion group to document 80 hours of work or qualifying activities per month. Previously, Medicaid eligibility was not contingent on meeting a work or reporting requirement. The Congressional Budget Office estimates that the work requirement provisions included in the bill could reduce federal spending by $344 billion (total Medicaid spending is estimated to be $655.9 billion in FY 2025) but result in 11.8 million more people being uninsured by 2034.
Most Medicaid recipients (92 percent) under the age of 65 already work full- or part-time jobs, according to KFF. The bill also includes exemptions from the requirements for certain adults, including parents of dependent children and those who are medically frail. These requirements would take effect nationally no later than December 31, 2026.
