Medicaid Work Requirements: Engaging Clinics and Pharmacies to Prevent Disenrollment

Policy Points The One Big Beautiful Bill Act introduces the first nationwide Medicaid work requirement, replacing state-level variation with a uniform federal standard. Past state experiences show that poor reporting design drives most procedural disenrollments-highlighting the need for accessible, integrated verification systems. Leveraging primary care clinics and community pharmacies for work verification, supported by sustainable reimbursement models, could preserve coverage for eligible beneficiaries while meeting program integrity goals.

The One Big Beautiful Bill Act, enacted on July 4, 2025, established the first nationwide Medicaid work requirement, replacing prior state-specific Section 1115 demonstrations with a uniform federal standard. Historical evidence from welfare programs and Medicaid pilots, particularly in Arkansas, suggests that while work or community engagement requirements may have moderate public support, poorly designed reporting systems and administrative barriers can lead to substantial procedural disenrollment without measurable employment gains.

This perspective outlines a framework for leveraging high-touch health care settings-primary care clinics and community pharmacies-to facilitate verification of work or community engagement hours. These sites already maintain frequent contact with Medicaid beneficiaries, have established billing relationships with Medicaid, and can provide physical access points that mitigate digital-access disparities. Policy options for provider compensation include fee-for-service payments per verification or capitated per-member-per-month arrangements.

By integrating verification into trusted, accessible care settings, states can reduce administrative burden, preserve coverage for eligible beneficiaries, and align One Big Beautiful Bill Act's implementation with program integrity goals.