Medicaid Work Requirements: Engaging Clinics and Pharmacies to Prevent Disenrollment

Area of Science:

• Health Policy
• Public Health Administration
• Healthcare Systems

Background:

• The One Big Beautiful Bill Act (July 4, 2025) established the first federal Medicaid work requirement, superseding state-level variations.
• Past welfare and Medicaid programs indicate that flawed reporting systems cause significant procedural disenrollments, often without improving employment outcomes.

Purpose of the Study:

• To propose a framework for verifying Medicaid work requirements.
• To leverage existing healthcare infrastructure for efficient and accessible verification processes.

Main Methods:

• Utilizing primary care clinics and community pharmacies for work/community engagement hour verification.
• Exploring reimbursement models such as fee-for-service or capitated payments for providers.

Main Results:

• Primary care and pharmacies offer high-touch, accessible points for verification, addressing digital disparities.
• Integration can streamline administrative processes and maintain program integrity.

Conclusions:

• Leveraging healthcare settings for verification can reduce administrative burdens.
• This approach helps preserve coverage for eligible Medicaid beneficiaries.
• Aligns implementation with program integrity goals of the One Big Beautiful Bill Act.