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Congressional Republicans are looking for ways to offset the proposed tax cuts and are trying to mandate millions of Americans working to get federal subsidies insurance. The GOP Tax and Budget Bill passed the House in May, with Senate Republicans working diligently to advance draft federal spending cuts in the coming days.
Georgia, the only state with Medicaid mandate, began experimenting with requirements on July 1, 2023. As an approach to commemorate the Medicaid program’s second anniversary, Georgia has registered only a few eligible people. As of May 2025, around 7,500 of the approximately 250,000 eligible Georgians were registered, despite state statistics showing that 64% of that group were working.
Gov. Brian Kemp has long defended Medicaid reform, arguing that it should move away from government-run healthcare. His spokesperson also told Propoblica that the program, known as the Georgia coverage pathway, is not designed to maximize enrolment.
Healthcare analysts and former state Medicaid officials say Georgia’s experience shows that if the legislative bill becomes law, taxpayers will spend hundreds of millions of dollars in administrative costs while threatening nearly 16 million people.
Here’s how federal labor requirements are proposed compared to Georgia, and how it affects your state:
How does the nation decide who qualifies?
What Congress proposes:
The House Bill, HR 1, and the draft Senate proposal require all states to ensure that Americans aged 19 to 64 with Medicaid-funded health insurance work 80 hours a month to train, study or volunteer for work. These new verification systems must be implemented by December 31, 2026, and require that you check the work status of residents who are registered twice a year. This means that those who have already received compensation based on their income level should regularly prove eligibility.
Federal labor requirements apply to more than 10 million low-income adults with Medicaid coverage and roughly five million residents in 40 states who have accepted federal grants to purchase private health insurance through what is commonly known as Obamacare.
The House bill exempts parents with children under the age of 18 from the new requirements, while the Senate version exempts parents with children under the age of 15. Bill also does not exempt anyone looking after his elderly relatives.
Georgia experience:
Georgia’s mission applies to fewer people categories than proposed federal laws. Still, authorities were unable to meet the state’s strict monthly verification requirements to ensure technical flaws and employment of people working in informal economies such as house cleaners and landscapers. The challenge was steep enough, with Georgia decided to loosen its job verification protocols from monthly to once a year.
What does this mean for your situation:
The Congressional Budget Office estimates that HR 1 will result in at least 10 million low-income Americans losing their health insurance. Healthcare advocates say that it’s not because they’re not working, but because of the bureaucratic hoop, they’ll have to jump on to prove their employment. A study by the health policy think tank KFF found that the majority of people covered by the new law are required to be already working, registered in schools or not staying in a home caregiver, limiting their ability to earn salaries elsewhere.
Arkansas is the only state other than Georgia, implementing work requirements. Republican state lawmakers later changed their minds after data showed that the deficits associated with eligibility had lost compensation within the first months of the policy. A federal judge ruled that the program was suspended in 2019 and increased the state’s uninsured fees without evidence of increased employment.
House Speaker Mike Johnson Credit: via Tom Williams/CQ Roll Call AP
House Speaker Mike Johnson, Louisiana Republican, says the HR 1 Medicaid job requirements are “common sense.” He says the policy does not result in losses in American health insurance, which Medicaid originally designed to support, as work requirements do not apply to these groups: children, pregnant women, and elderly people living in poverty. He points to $344 billion in 10-year estimated cost savings due to Medicaid labor requirements, which are beneficial to the country’s financial health. “You find dignity in your work, and those who don’t do it will try to get their attention,” he said earlier this year.
Who pays for the state’s work verification system?
What Congress proposes:
The House bill allocates $100 million to help pay a verification system that determines someone’s eligibility. The grant will be distributed proportionally to the state’s share of Medicaid enrollees covered by the new requirements. This is the amount that health policy experts say is not enough. The state says it is in the hook because of the difference.
Georgia experience:
In the two years since Georgia began experiments using work requirements, it has been implementing the route, spending nearly $100 million mostly on federal funds. Of that, $55 million was directed towards building a digital system to verify participants’ eligibility.
Like other states, Georgia already had a work verification system for its food stamp program, but had contracted with Deloitte Consulting to handle new Medicaid requirements. Officials in Georgia said the state spent 30% more on the rise in consultants and it was planning to create a digital platform for the Pathways because of the cost. Deloitte previously refused to answer questions about the work of that route.
What does this mean for your situation:
While all states have already verified the work requirements for food stamp recipients, many existing systems require an upgrade to comply with proposed federal laws, according to three former state Medicaid officials. In 2019, when the state last looked into job requirements, a nonpartisan government accountability investigation predicted that Kentucky would reach $200 million in administrative costs.
Congressman Buddy Carter Credit: Justin Taylor/Current GA/Catchlight Local
Rep. Buddy Carter, a Republican who chairs the House Energy and Commerce Committee’s Health Subcommittee, who representing Georgia coast and recommended Medicaid cuts for HR 1, said the state’s upfront costs will be offset by the long-term savings promised in the House bill. Some Congressional Republicans have acknowledged that cost savings will be obtained from fewer people registering with Medicaid due to the new requirements. According to the Congressional Budget Office, labor obligations are 43% of the proposed $793 billion Medicaid cuts.
How does the state put staff in the program?
What Congress proposes:
Medicaid is a federal social safety net program managed differently in each state. Neither HR 1 nor the Senate legislative proposal provides a blueprint for how states validate eligibility or how the costs of overseeing new requirements will be paid.
Georgia experience:
Georgia’s experience shows that state caseworkers are key to managing the validation of application and job requirements for Medicaid-qualified residents. The agency that handles federal benefits registrations had a staff vacancy rate of about 20% when Georgia launched its work requirements policy in 2023. As of March, the agency had a backlog of over 5,000 route applications. The agency said it would require another 300 caseworkers, according to a report submitted to state legislators in June, and will upgrade to better manage the backlog.
What does this mean for your situation:
Former Medicaid officials and health policy experts say Georgia’s staffing struggle is not unique. In 2023, near the end of the Covid-19 public health emergency, KFF looked into the state for staffing levels of caseworkers confirming eligibility for federal benefits, including Medicaid. Worker vacancy rates exceeded 10% in 16 of the 26 states that responded. Prices exceeded 20% in seven of these states.
He became the face of Georgia’s Medicaid work requirements. Now he’s tired of it.
Adding caseworkers will increase the cost of the state. Currently, 41 states need a balanced budget. This means that these state legislators will need to increase their taxes and income to ensure that Medicaid enrollees are working or that they will reduce registrations to reduce costs.
In the large states, about half a dozen large states where county governments manage federal safety net programs, the cost of training caseworkers with new verification protocols could flow from state to county.
Sen. Lisa Murkowski, an Alaskan Republican, told reporters in June about the costs her state faces to meet the requirements of her state’s bill.
