Medicaid Work Requirements: Implications for Low Income Women’s Coverage

Work requirements for Medicaid enrollees have once again resurfaced, now as part of a broader legislative package of potential changes for the Medicaid program aimed at reducing federal spending. Given that women make up over half of adult Medicaid enrollees and women’s well documented role taking on childcare and family responsibilities, Medicaid work requirements would heavily impact women in the program. Full details of the work requirements proposal are still unknown, but analysis of previous legislation from the Congressional Budget Office found that while national work requirements would lower federal spending, they would lead to a drop in Medicaid enrollment and an increase in the number of people who are uninsured but would not increase employment.

The first Trump Administration made a significant change to the Medicaid program by giving states the option to impose work requirements as a condition of Medicaid eligibility through Section 1115 waivers. While 13 states received approval for work requirement waivers, many were struck down in court and the Biden administration rescinded the remaining waivers. Today, only Georgia has a Medicaid work requirement in place for parents and childless adults with incomes below 100% of the federal poverty level (FPL) who are newly eligible through the state’s Pathways waiver. However, several states have submitted or are developing new 1115 waivers or considering legislation to condition Medicaid eligibility on meeting work and reporting requirements.

Medicaid, the nation’s health program for low-income people, provided health and long-term coverage to one in five adult women ages 19 to 64 in 2023. Imposing work requirements in Medicaid would heavily impact women on the program and could lead to Medicaid coverage losses not only for those who lose eligibility because they don’t work or meet an exemption but also among people who remain eligible for the program but lose coverage due to new administrative burdens or red tape. This data note documents differences by sex in the work status of adult Medicaid enrollees ages 19-64 who were not receiving Supplemental Security Income (SSI) and were not dually eligible for Medicare in 2023, and highlights differences by parent status.

What is the work status of women and men covered by Medicaid?

Over nine in ten women and men on Medicaid were working full or part-time for pay or were not working because of caregiving responsibilities, illness or disability, or school attendance in 2023 (Figure 1).¹ More than half of men (54%) and more than a third of women (36%) on Medicaid worked full-time during the year. A larger share of women (24%) compared to men (15%) worked part-time. Four in ten (40%) women and three in ten (31%) men enrolled in Medicaid did not work for pay in 2023, most for reasons that would likely exempt them from work requirements.

Among Medicaid adults who are not working, women are more likely to cite caregiving responsibilities while men are more likely to report an illness or disability as reasons for not working. One in five (19%) women enrolled in Medicaid did not work in 2023 because of caregiving responsibilities, compared to 4% of men (Figure 1). One in ten (9%) women said they did not work because of an illness or disability and 6% did not work because they were going to school. Similar shares of men and women report school as the reason they did not work. All the leading reasons women cite for not working would likely qualify for exemptions from state-level Medicaid work requirements. Depending on how work requirement policies are crafted, women who are exempt may have to submit paperwork to document the reasons for their exemption to remain eligible for Medicaid coverage.

Many Medicaid enrollees are working in service jobs with few benefits, such as health insurance and paid sick days. The top industries that employ women with Medicaid are the restaurant and food service industry, schools, and hospitals, while men tend to work in construction, the restaurant and food service industry, and landscaping services (Appendix Table 2).

What are the reasons that some adults work part-time?

Women were more likely than men to cite family obligations and child care issues as reasons for working part-time. Almost one in four (24%) women with Medicaid worked part-time in 2023 compared to one in seven (15%) men (Figure 2). Women were more likely than men to report they worked part-time because of family or personal obligations (27% vs. 12%) or child care problems (12%; data for men suppressed because it did not meet the minimum standards for statistical reliability). Four in ten men and three in ten women said they worked part time because of slack work/business conditions, they could only find part-time work or because their work week was less than 35 hours. Similar shares of women and men with Medicaid coverage worked part-time because of school or training responsibilities or because of health or medical limitations. Individuals who are working part-time are often ineligible for benefits even if they are offered by their employers, particularly health insurance coverage.

What is the work status of mothers and fathers with Medicaid coverage?

Parents with children under 18 – both mothers and fathers – with Medicaid were more likely to work for pay in 2023 than Medicaid adults without dependent children, but fathers were more likely to work than mothers. Just under half (48%) of women ages 19 to 64 with Medicaid have children under 18 as do one-third of men on the program. About two-thirds (64%) of women with children under 18 and 87% of men with children under 18 worked full or part-time compared to 56% of women and 59% of men without children under 18 (Figure 3). Fathers were more likely to work full-time compared to mothers (78% vs. 40%) in 2023. The leading reason cited by mothers for not working (28%) was they were taking care of children and family.

Among women and men without children, the leading reason for not working was an illness or disability (13% and 15%, respectively). One in ten women and men without children reported they were not working because they were going to school (10% and 9%, respectively). Notably, even among women without children, over one in ten (11%) said they were not working because of caregiving responsibilities, which could include caring for adult children or aging or ill parents (Figure 3). Caregiving responsibilities generally consume a lot of a person’s time and could make it difficult to meet paperwork requirements to file for exemptions from work requirements.

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