Medicaid Work Requirements Don’t Work. But If States Use Them, They Must Do Better.
When I served as Secretary of Health in Louisiana, we were preparing to implement Medicaid work requirements. We reviewed the data. We looked at what had happened in other states. We listened. And ultimately, we made the decision not to move forward.
Here’s why.
The Data Was Clear
Most people on Medicaid were already working. Those who weren’t were facing serious physical or mental health challenges that prevented them from doing so.
In no state did work requirements actually lead to an increase in employment.
Building and running the systems needed to enforce work requirements would have cost Louisiana nearly $90 million — far more than any savings from disenrolling people or increased tax revenue from new employment.
Work requirements might sound like a path to self-sufficiency. But in practice, they punish people for being poor or sick. That’s not good policy. And it’s certainly not healthcare.
What to Consider If They’re Moving Forward
If we’re going to impose work requirements anyway, there are critical things states must consider.
Avoid costly, siloed tech systems. These policies often turn into massive windfalls for consulting firms that build expensive, proprietary platforms that don’t work well or connect with other state systems. And benefit those companies rather than the health of families.
Use data states already have. Don’t create new layers of bureaucracy just to track compliance.
Invest in real pathways out of poverty. That means job training, volunteer opportunities, and connections to education, not just paperwork and penalties.
The new requirements target parents of children over 14. That means asking people, mostly women, who have been out of the workforce for over a decade to suddenly find employment, often without transportation, childcare, or support. In Louisiana, we began partnering with community colleges to create training pathways that helped people find jobs. That’s the kind of effort required if this policy is going to be anything more than a coverage cut in disguise.
Health Care Shouldn’t Be Conditional
I understand the instinct behind work requirements. Many Americans believe everyone should contribute. I agree. But I also know we can’t walk in everyone’s shoes. Health care is foundational. Denying access to it doesn’t help people contribute, it keeps them locked out.
As a physician, a mother, and a policymaker, I can’t support a system that withholds preventive care from families just because they don’t meet an arbitrary requirement. That’s not just immoral. It’s inefficient, ineffective, and expensive.
I’ve had promising conversations with policymakers on both sides of the aisle, including Republican Senate staff who say they want a smarter and more humane approach. If that’s true, this is the moment to prove it.
