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How would implementing an Arkansas-style work requirement affect Medicaid enrollment? [1]

['Richard G. Frank', 'Dominic Hodgkin', 'Maureen Stewart', 'Shay M. Daily', 'Haiden A. Huskamp', 'Matthew Fiedler', 'Rachel Sachs', 'Christen Linke Young', 'Stuart M. Butler']

Date: 2025-07

Executive summary

Congressional Republicans are expected to consider a Medicaid work requirement as part of upcoming reconciliation legislation (e.g., Sanger-Katz 2025; Hooper and Payne 2025). Proposals vary in who they apply to and what they direct enrollees to do, but they generally require adult enrollees to be employed (or engaged in another approved activity, like schooling) for some number of hours per month to remain eligible for Medicaid, subject to some exemptions.

To inform this pending debate, this paper examines one of the few precedents for such a policy: a work requirement implemented by the state of Arkansas under a waiver granted by the first Trump administration. Arkansas applied its policy for nine months, from June 2018 through February 2019, before being stopped by a court ruling. The Arkansas policy closely resembles the federal work requirement passed by the House of Representatives as part of the Limit, Save, Grow Act of 2023, a potential starting point for upcoming reconciliation legislation.

Prior research has shown that Arkansas’ policy reduced Medicaid enrollment and increased uninsurance among low-income adults in Arkansas (Sommers et al. 2019; 2020; Gangopadhyaya and Karpman 2025). This research also finds that the number of enrollees that the state deemed non-compliant with the requirement far exceeded the number of enrollees who neither qualified for an exemption nor were engaged in the required activities, indicating that most enrollees lost coverage due to challenges in reporting information to the state, not true non-compliance with the policy. Meanwhile, this research finds no evidence that the Arkansas requirement increased employment among the population subject to the policy, contrary to proponents’ hopes.

Because the Arkansas policy was in effect for a short time—and, indeed, was still phasing in when it was stopped in court—it is not straightforward to use the Arkansas experience to assess how this policy would have affected Medicaid enrollment over the long run. To overcome this obstacle, this paper develops a dynamic structural model suitable for using the Arkansas experience to forecast the long-run enrollment effects of the Arkansas policy and similar policies.

My main findings are as follows:

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[1] Url: https://www.brookings.edu/articles/how-would-implementing-an-arkansas-style-work-requirement-affect-medicaid-enrollment/

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