Medicaid Work Requirements Will Kill Jobs and Weaken State Economies, Analysis Shows

May 1, 2025

Proposed national Medicaid work requirements could eliminate up to 449,000 jobs and shrink state economies by as much as $59 billion in 2026 alone, according to a new report from the Commonwealth Fund and the George Washington University Milken Institute School of Public Health. 

The report provides state-by-state estimates of projected coverage losses and economic harm if Republicans in Congress were to enact a proposal to impose a nationwide Medicaid work requirement for adults, ages 19 to 55 and without dependents, who gained coverage through Medicaid expansion. The analysis also estimates the effects of a separate plan specifically targeting the District of Columbia: that proposal seeks to sharply reduce the federal funding match for D.C.’s Medicaid program.

Among the key findings:

• As many as 5.2 million adults could lose their Medicaid coverage in 2026.
• State GDPs could shrink by as much as $59 billion.
• Up to 449,000 jobs could be eliminated.
• State and local tax revenues could fall by up to $4.4 billion.