Arkansas showed that Medicaid work requirements do not work

Arkansas Governor Asa Hutchinson announces work requirement changes to Arkansas Works, the state’s Medicaid expansion program. (Photo via Arkansas Nonprofit News Network)

PHOENIX VU: The One Big Beautiful Bill attempts a policy that has already been shown to fail. 

Arkansas became the first state to impose work requirements on certain Medicaid recipients in the summer of 2018. A federal judge quickly struck down the policy, but the damage was already done. In just a few months, over 18,000 Arkansans had lost their health care.  

Arkansas Works, the state’s Medicaid expansion program, initially required 30-to-49-year-old adults to spend 80 hours per month on work, school, volunteering or other approved activities with plans to expand to 19-29 year olds by 2019. Unless exempted for disability, having dependent children or other reasons, those who failed to comply for three months would lose coverage for the rest of the year. 

The core argument for welfare work requirements is two-fold: 1) It encourages employment and self-sufficiency and 2) too many people are on government assistance without contributing to society or the economy. To use the more blunt words of House Speaker Mike Johnson, “young men… need to be out working instead of playing video games all day”.

Neither is true. A Harvard study found that Arkansas Medicaid work requirements had no positive effect on employment over 18 months. An analysis from the Urban Institute came to a similar conclusion despite using different data and methods. Rather than increasing employment, it is likely the case that work requirements instead hurt employment because those who lose coverage may become too sick to work. 

One enrollee in Little Rock reported being “knocked out every day” because they were unable to afford their narcolepsy medication on their own after losing Medicaid. If policymakers really want to encourage work, they should instead expand Medicaid, which has been shown time after time to increase employment and improve people’s abilities to find and maintain work. 

Most people on Medicaid who can work, however, already do. Among working-age enrollees, 92% are either working, caregivers, ill, disabled or attending school. Of the remaining 8%, many report difficulties finding or maintaining work because of factors outside of their control. 

Much of Arkansas is rural, with work opportunities far and few in between. Perry County, for example, has a population of over 10,000 but only had about 1,100 jobs in the beginning of 2025. There simply were not enough jobs to go around. Volunteering, education and job training counted towards the 80 hour requirement and could increase employability, but these activities often cost money to participate and were not an option for those whose wallets were already being stretched thin. 

Even if an enrollee has a job, maintaining it is another challenge. Enrollees noted chronic health issues, having hours cut and a lack of dependable transportation as barriers to consistent employment. Medicaid recipients by nature have few funds to afford reliable transportation of their own, and some counties in Arkansas don’t even have a single stoplight, let alone public transportation. 

Work requirements are really work reporting requirements, and many Arkansans, including those already working, lost coverage because of difficulty navigating this confusing process. Enrollees were often unaware or misunderstood the work requirement changes which were only detailed in a confusing 10-page notification letter. 

Medicaid recipients had to report their hours on an online portal that closed every night from 9 p.m. to 7 a.m., but a quarter of households state-wide did not have access to broadband Internet around this time. Even when the website was running, it was so complex that people spent hours trying to navigate it or figure out their status. Overwhelmed call centers and caseworkers were of little help. Enrollees sat through hour-long wait times just to be hung up on. 

In the end, thousands of Arkansans fell through the cracks. Over 18,000 people, about 25% of the target population in the initial phase, lost coverage for failure to comply with a cruel and complicated system. Thousands more lost coverage due to paperwork issues. Medicaid is a source of stability and security that can help people get back on their feet. Employment should be an outcome of Medicaid, not a requirement. 

Arkansas Works should serve as a warning sign for the rest of the country as it begins implementing the OBBB’s Medicaid work requirements in 2027. Between 10 to 15 million Americans will be at risk of losing their health coverage, many of whom are already working. States will spend hundreds of millions on implementation and administration. Hospitals will absorb uncompensated care and likely pass the costs back onto other patients. 

Worst of all, unjustified losses in coverage will result in easily preventable sickness and death. 

Adrian McGonigal held a decent job working 30 to 40 hours a week at a poultry plant in Northwest Arkansas. He suffered from severe COPD, a chronic lung disease, but was able to receive consistent medical care through Medicaid for several years. After learning that he would have to report his work hours to stay on Medicaid, he overcame his difficulty of working with computers to successfully log his hours in June of 2018. 

But McGonigal didn’t realize he had to report his hours every month. When he tried to pick up his prescriptions in October, he was told he was no longer covered and would have to pay $800 out of pocket. Unable to afford his medication, his COPD flared up, causing him to miss several days of work due to hospitalization and eventually be fired. 

McGonigal died last November of a heart attack. I won’t speculate whether or not work requirements led to his death, but I will say that they failed him when he was alive. McGonigal lost his job, his health care, his way of life. After being fired, neither his health nor economic well-being recovered as he spent the rest of his life struggling in various jobs, earning less than he did at the poultry plant. 

McGonigal is not the exception. His story may be over, but there are many others just like him across the country – people who already work and rely on Medicaid to continue being contributing members of society. We cannot fail them too. 

Phoenix Vu is a columnist for On the Record and a Master of Public Policy student from Arkansas. He previously worked in politics and policy at the state and local level.