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Work Requirements and Health: Projected Mortality Impacts of Medicaid Coverage Loss

Pandey, A.; Ye, Y.; Singer, B. H.; Galvani, A. P.

2025-03-04 health policy
10.1101/2025.02.28.25322887 medRxiv
Show abstract

Recent legislative proposals to impose nationwide work requirements for Medicaid eligibility could jeopardize health insurance coverage for over 36 million low-income Americans. To assess the potential mortality impact, we estimated annual excess deaths under a comprehensive set of scenarios reflecting varying policy implementations. These scenarios accounted for differences in age groups (19-55 vs. 19-64), eligibility based on Medicaid expansion status, and varying levels of automatic exemptions and reporting compliance. In the most optimistic scenarios--where work requirements are applied only to Medicaid expansion enrollees--we project 4,936 and 10,851 excess deaths annually among individuals aged 19-55 and 19-64, respectively. Under the most regressive scenario, where work requirements are imposed on all non-disabled Medicaid enrollees aged 19-64, the estimated annual excess deaths rise sharply to 53,144. These projections underscore the grave public health consequences of implementing Medicaid work requirements and highlight the need for careful evidence-based policymaking.

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