Controversial work requirements added to the Medicaid program were intended to ensure that able-bodied adults are earning paychecks and enrolled in employer-provided healthcare coverage whenever possible.

Critics say the way the new requirement is being implemented, though, creates barriers that could boot people from Medicaid even if they are working.

The Big Beautiful Bill signed into law last summer by President Donald Trump mandates that most adults enrolled in Medicaid must work or do other qualifying activities at least 80 hours a month. However, a final rule issued by the Centers for Medicare and Medicaid Services added language requiring that medically vulnerable people must not only be diagnosed with an illness that could prevent them from working, they must also demonstrate that they are impaired so significantly they can’t work.

Gov. Josh Shapiro signed onto a lawsuit filed in Massachusetts in June challenging the CMS’s more restrictive interpretation of the Medicaid work requirement.

For Medicaid recipients, even if they have jobs, satisfying the 80-hour work requirement may be out of their control because they may not set their own work schedules.

James Luby, from Scranton, told reporters he relies on Medicaid because he works as a stage hand for theatrical productions and other performances.

“I work Scranton, I work Wilkes Barre, I work Hershey. I work in the Central Susquehanna, and that’s common because these are all part-time jobs stitched together to make a career, you know,” he said. “There’s no employer-

sponsored healthcare, not typically. And so Medicaid really, really works.”

Having Medicaid allows Luby to better manage his autism and hypertension. But because his work hours vary, he may not always meet the minimum required work hours to remain enrolled in Medicaid.

“I just can’t imagine what I would do,” he said. “I would be so worried. It would be so disruptive to not have Medicaid.”

Enrollment drop

State officials had estimated that the Medicaid changes would bump more than 300,000 Pennsylvanians out of the program. Data released in June by the state Independent Fiscal Office shows that about 100,000 people in Pennsylvania have already left Medicaid even though the work requirements don’t take effect until 2027.

The IFO report noted, though, that work requirements for people enrolled in the Supplemental Nutrition Assistance Program are already in effect.

That may have driven some people out of both SNAP and Medicaid, particularly if those individuals left the safety net programs because they got better jobs with employer-

provided health insurance.

Employment data from the Department of Labor and Industry shows that there were 103,000 more people working in Pennsylvania in May than there were working in the state during the same month in 2025.

The IFO report also noted that some of the drop in enrollment in the safety net programs could also be related to concerns about immigration enforcement. Children who are U.S. citizens can get Medicaid coverage if their parents are not citizens. But the fiscal office noted that families may be dropping out of safety net programs because of immigration crackdowns.

U.S. Rep. Brendan Boyle, D-Pa., the ranking Democrat on the House Budget Committee, said that when the bill was being debated, he and other opponents of the measure pointed to a variety of independent analyses that estimated that between 15-17 million Americans would lose health coverage.

“It turns out the numbers were a little bit off. The damage is even worse than the dire projections of a year ago,” he said on a press call organized by the Pennsylvania Health Action Network. “Already, more than 8 million Americans have lost their healthcare coverage as a result of that bill. And remember, that’s just the beginning. There are at least 8 million more who will be losing their healthcare coverage, particularly come this December, once those Medicaid cuts come into effect.”