Medicaid’s Work Requirements: Why the Safety Net May Be Slipping Through the Cracks
For years, Eric Wunderlin struggled to find his footing. Living in Dayton, Ohio, and grappling with both clinical depression and diabetes, he cycled through low-wage, part-time retail jobs that barely paid enough to cover rent. Most months, he faced a cruel choice: feed himself or his cat, Annabelle.
Then, in 2018, something changed.
His Medicaid health plan through CareSource didn’t just offer medical coverage—it offered a lifeline. He was connected with a life coach who helped him land a full-time job with benefits. Today, Wunderlin works at a nonprofit social services agency. For the first time in his adult life, he feels stable enough to dream—of travel, of a future.
“I finally feel like a real person who can go out and do things,” says Wunderlin, now 42. “It’s like I pulled myself out of that depression.”
To some, Wunderlin’s story sounds like the perfect case study for supporters of Medicaid work requirements—policies gaining traction among Republicans in Congress and in states like Ohio, Iowa, and Montana. The idea: require nondisabled adults on Medicaid to work or participate in job-related activities to promote self-sufficiency and reduce dependency on public aid.
But success stories like Wunderlin’s are rare—and highlight what’s missing in the broader conversation.
The Problem With Work Mandates: All Stick, No Ladder
While CareSource happened to offer meaningful job assistance, most Medicaid plans don’t. And even when help exists, it’s limited. Nearly two-thirds of adult Medicaid enrollees already work, while many others are full-time caregivers, students, or managing serious health issues that make steady employment unrealistic, according to KFF Health News.
“There’s this assumption that people on Medicaid just don’t want to work,” says Ben Sommers, professor of health economics at Harvard T.H. Chan School of Public Health. “But the data simply doesn’t back that up.”
The Trump administration approved work requirements in 13 states. But most were blocked by courts or rolled back by the Biden administration—except for a limited program in Georgia. When Arkansas implemented its own work mandate in 2018, more than 18,000 people lost coverage in under a year—not because they weren’t working, but because they couldn’t navigate the confusing red tape.
Where Work Support Works
Still, some programs show that when job support is built into the system, it can change lives.
CareSource’s JobConnect program matches enrollees with life coaches who help with everything from interview prep to résumé writing. Since 2023, it’s helped roughly 800 people find jobs. In fact, CareSource has hired 29 of its own Medicaid enrollees into full-time roles across departments like pharmacy and customer service.
“Work requirements alone don’t create stability,” says Farah Khan, a fellow at the Brookings Institution. “Economic mobility needs a ladder—not a stick.”
Other states are catching on. In California, Medicaid began offering non-traditional benefits in 2022—including housing assistance, mental health care, and job training—for people experiencing homelessness or severe mental illness. Nearly 280,000 individuals have received services, though job placement data isn’t yet available.
Pennsylvania’s UPMC health system has taken a bold step further. Through its Pathways to Work program, UPMC has hired over 10,000 of its Medicaid enrollees into entry-level jobs since 2021. Former low-wage workers now fill positions like warehouse staff, call center agents, and medical assistants—with full benefits and real upward mobility.
“Our program shows what’s possible when healthcare and employment support are aligned,” says Dan LaVallee, senior director at UPMC’s Center for Social Impact.
When Good Ideas Fail in Practice
But not all efforts succeed.
In Montana, lawmakers once backed a promising program that connected 32,000 Medicaid recipients to existing workforce services. Then, the state outsourced it to private contractors. By 2024, only 11 people remained in the program.
“There wasn’t a strong support component,” says Sarah Swanson, head of Montana’s Department of Labor. The state is now trying to reboot the program by restoring partnerships with public agencies.
Meanwhile, in Ohio, state officials note that Medicaid plans aren’t job agencies—and most don’t track employment outcomes. Yet as the GOP pushes for deeper Medicaid cuts and tighter eligibility rules, many enrollees remain stuck in a cycle where they want to work but lack the training, support, or health to do so.
One Success, Thousands Still Waiting
For every Eric Wunderlin, there are thousands more who want the same opportunity—but face a system designed more for punishment than progress.
Until Medicaid reforms shift their focus from enforcing work to enabling it—with the right resources and support—stories like Wunderlin’s will continue to be the exception, not the rule.