New Republican-led proposals in Congress seek to tie Medicaid eligibility to work requirements, a move that could cause over 1 million Californians to lose health insurance, particularly among the state’s poorest and most vulnerable residents.
Key Points:
- The proposed federal rules would require low-income adults to work a certain number of hours to maintain Medicaid (Medi-Cal in California) coverage.
- A KFF (Kaiser Family Foundation) analysis estimates that 1 million Californians could lose coverage if such rules are enforced.
- Many affected are already working in informal or part-time jobs, or face barriers like language, caregiving, or health issues.
- Past attempts at similar rules in other states led to massive coverage losses, even among those who were technically exempt.
- California lawmakers and health advocates are strongly opposed to the proposal.
Background and Implications
Who Would Be Affected?
The proposed requirements target non-disabled adults under 65 without dependents—many of whom are:
- Immigrants
- Gig or low-wage workers
- Individuals with unstable housing or caregiving responsibilities
California expanded Medicaid under the ACA, and currently 15 million residents rely on Medi-Cal. The state has prioritized broad access, including recent expansions to cover all income-eligible adults regardless of immigration status.
State Response
Health policy experts and state officials argue that adding work requirements could reverse years of progress, disproportionately harming vulnerable communities. Enforcement would also be costly and inefficient.
