The Human Side of Medicaid Work Requirements: United States of Care Launches Two-Year Enrollee Study

Longitudinal research will follow real people navigating coverage and compliance as H.R. 1 implementation unfolds

WASHINGTON, D.C. — Today, United States of Care (USofCare) announced the launch of a comprehensive research initiative to explore the experiences of people covered by Medicaid as newly imposed work requirements take effect in states. The two-year study will follow enrollees across five states — Idaho, Missouri, North Carolina, Pennsylvania, and West Virginia — through five rounds of in-depth interviews timed to several critical federal and state policy milestones. The states reflect a wide range of Medicaid expansion histories, political environments, administrative capacities, and challenges to navigating the work requirements process for people. Participants will be selected from a diverse cross-section of enrollees representing a range of ages, genders, racial and ethnic backgrounds, geographic regions, and employment statuses.

“We’ve spent years listening to what people need from the health care system — and we know that the fear of losing health care coverage when they need it most is a core concern,” said Dr. Venice Haynes, Senior Director of Research and Community Engagement at United States of Care. “As Medicaid undergoes major changes for certain enrollees, we need to understand how people who depend on the program experience these changes, and how these new rules impact their ability to stay covered. We’re listening to people directly impacted to track their challenges, concerns, and needs as this unfolds.”

USofCare will release findings throughout the duration of the research project having asked key questions, such as:

• What level of awareness do people have about work requirements and what is expected of them in order to maintain their coverage?
• What barriers are people encountering in demonstrating compliance with — or obtaining exemption from — work requirements?
• How do new administrative or paperwork burdens associated with these requirements impact their health and economic stability?
• How differently do people’s experiences vary by state in light of these new requirements?

This initiative begins as Medicaid undergoes a significant structural change. The One Big Beautiful Bill Act (H.R. 1) established, for the first time nationally, that Medicaid expansion coverage be conditioned on certain enrollees demonstrating participation in employment, education, or volunteer service beginning on January 1, 2027. H.R. 1 also doubles the frequency of eligibility verification, requiring enrollees to prove eligibility every six months instead of annually.

On June 1, 2026, the Centers for Medicare & Medicaid Services issued an interim final rule outlining the policies around implementation of work requirements, including defining who is subject to work requirements, which activities meet these requirements, and what circumstances would allow someone to be exempt from these requirements. The rule narrowed exemptions for people who are “medically frail” beyond what states anticipated, and added new administrative challenges to an already complex federal mandate.

“H.R. 1 and the Medicaid policy implementation decisions being made in Washington and by state leaders right now will affect people’s lives — and their health — for years to come,” said Natalie Davis, CEO of United States of Care. “The goal of this research is to ensure that policymakers don’t lose sight of that. We’re making sure that the impact these changes have on real people — and what policymakers should do to respond — is at the core of the public conversation.”

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