Medicaid Work Requirements: Key Concerns for Adults with Mental Health Disorders
Recently, the House approved a budget reconciliation bill that would implement nationwide Medicaid work requirements for adults covered under the Affordable Care Act (ACA) expansion group. According to estimates from the Congressional Budget Office (CBO), this measure is projected to lower federal Medicaid spending by $344 billion over the next decade and result in an additional 4.8 million people losing health insurance.
On June 16, the Senate Finance Committee introduced revised reconciliation language that made notable adjustments to the Medicaid work requirement provisions; however, these details are subject to change as the Senate continues its discussion of the bill. According to the bill passed by the House, adults who gained coverage through the ACA Medicaid expansion must complete 80 hours per month of work or other approved activities, unless they qualify for certain exemptions—such as having a substance use disorder (SUD) or a “disabling” mental health condition. States are required to check compliance at application, renewal, and at least every six months, with enforcement starting no later than December 31, 2026. Those who do not meet these requirements may be denied or removed from coverage.
What You Should Know
Medicaid work requirements present significant hurdles for adults coping with mild or moderate mental health disorders. Many must regularly prove they’ve worked a set number of hours—often at least 80 per month—to maintain coverage. Yet, conditions like depression and anxiety are frequently episodic, making sustained employment challenging. People whose disorders aren’t officially classified as “disabling” must still meet work requirements, and those with undiagnosed conditions can struggle to secure needed exemptions.
The verification process itself can be unforgiving. For example, states may use a “look-back” period—reviewing recent months of work history—and often require official diagnoses or extensive documentation. Delays in claims processing and difficulties navigating exemption applications leave many without coverage when they need it most. If an enrollee misses work due to mental health symptoms, even briefly, they risk losing Medicaid coverage and access to treatment.
These disruptions can worsen health, leading to job loss and further instability. For those with substance use disorders, a sudden stop in treatment can have life-threatening consequences. Ultimately, continuous access to mental health care is crucial—not just for individual well-being, but for enabling ongoing employment and stability.
Given the complexity and frequent changes in healthcare requirements, it is especially essential for individuals with chronic or ongoing mental health issues to seek assistance in navigating these processes. Understanding how to document work hours, apply for exemptions, and respond to verification notices can be overwhelming, particularly when managing fluctuating symptoms. Accessing help from healthcare navigators, social workers, advocacy organizations, or legal aid can make a critical difference in ensuring that individuals maintain their coverage and access to treatment.
Stay Informed, Keep Up-To-Date
Additionally, staying informed about updates to Medicaid policies and healthcare news is vital. Policy changes can affect eligibility, reporting processes, or available exemptions—sometimes with little notice. By keeping up to date with the latest healthcare developments, individuals can be proactive about meeting requirements, securing necessary documentation, and avoiding gaps in coverage that could jeopardize their health and stability. For those living with ongoing mental health conditions, having reliable support and current information helps safeguard their access to essential care and supports their ability to remain employed and engaged in their communities.
For a deeper look at this issue, read the KFF piece “Implications of Medicaid Work and Reporting Requirements for Adults with Mental Health or Substance Use Disorders.”
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