President Trump signed the budget reconciliation bill known as the 'One Big Beautiful Bill' on July 4, 2025, which included the first nationwide Medicaid work requirement since the program was established in 1965. The requirement mandates that able-bodied adults ages 19 to 64 who receive Medicaid must work, participate in job training, or perform community service for at least 80 hours per month to maintain eligibility. States could begin implementing the requirement as early as January 1, 2026. These facts are confirmed by the Congressional Budget Office, Fox News, NPR, CNN, and the Centers for Medicare and Medicaid Services.

The Congressional Budget Office estimated that the work requirement provision, combined with other Medicaid changes in the bill, would result in 8.6 million people losing Medicaid coverage at the low end, with some analyses suggesting as many as 18 million depending on how states implemented the rules. The bill also included per-capita caps on federal Medicaid spending for certain populations, which CBO said would shift costs to states over time.

Supporters argued the requirement would encourage employment among able-bodied recipients and reduce dependency on government programs. The bill included an exemption for people with disabilities, caregivers, students, and individuals who were medically unable to work, though implementation of the exemptions was left largely to states.

NPR and CNN emphasized that prior state-level work requirement experiments — in Arkansas and Georgia — led to large coverage losses primarily because people failed to navigate complex paperwork, not because they were actually unemployed. Fox News and the Daily Wire framed the requirement as a 'common-sense' reform, noting polls showed majority support for the concept. Legal challenges were filed in multiple federal courts within days of signing.