As Medicaid Popularity Soars, State Legislatures Try to Undermine the Program in Secret

State legislatures across the country are nearing the end of their sessions and lawmakers in some states have stepped up their attacks on Medicaid by passing bills that will make it harder for people to maintain their health coverage, jeopardizing their health and financial security. In some cases, legislators have snuck in harmful and damaging Medicaid changes through last-minute, late-night maneuvers that suppress public debate and ignore the will of voters.

One misguided policy making its way into bills in several states is work reporting requirements for people with Medicaid coverage. Such policies are fueled by misinformation that people who receive their health coverage through Medicaid do not work. In reality, more than 92% of Medicaid enrollees are already working, or else have an important reason for being out of the workforce such as attending school, caring for young children or living with a disability.

These requirements create unnecessary paperwork and red tape designed to push eligible people off Medicaid — including working parents, rural Americans and veterans. And for what? Evidence shows Medicaid work reporting requirements do not improve employment and cost states millions of dollars to administer. It’s simple, work reporting requirements don’t work.

Voters are paying attention, and they are not happy. Thanks in part to powerful advocacy campaigns such as “Hands Off Medicaid” and “I Am Medicaid,” Americans are making their voices heard at town halls across the country, saying “no” to work reporting requirements and other destructive policies that will harm their communities.

Knowing that direct attacks on Medicaid are deeply unpopular — while the program itself remains popular — some conservative state lawmakers have turned to concerning backdoor tactics to push through their misguided agendas. Below are a few examples of tactics advocates should be aware of and states to watch.

Late-Night Votes and Last-Minute Substitutions

Kentucky: In the final hours of this year’s legislative session, lawmakers added new language and passed a bill that seeks to impose a work reporting requirement on adults with Medicaid coverage in the state. The Republican supermajority in both chambers overrode the Governor’s veto, passing the bill into law and giving the green light for the state to seek federal approval to implement this harmful program. If approved by the Trump Administration, Kentuckians aged 18-60 would be subject to a 20 hour/week work reporting requirement and would be in danger of losing their coverage if not in compliance. A similar requirement proposed in 2016 estimated that nearly 100,000 Kentuckians would lose Medicaid coverage.

Iowa: A Senate passed bill directs the state to seek federal approval for an 80 hour/month work reporting requirement for adults on the Iowa Health and Wellness Plan. According to state estimates, approximately 32,000 low-income Iowan adults could lose their health coverage as a result. Lawmakers had originally debated a 20 hour/month requirement, but, in a last minute switch, they increased the proposal to 80 hours/month. By design, there was little time for the public to review this huge increase before the bill passed. The bill also includes a trigger provision that would end Medicaid expansion if the federal government does not approve work reporting requirements. Governor Reynolds, who has already stated her desire to pursue work reporting requirements, is likely to approve the bill.

Overriding Medicaid Expansion Voter Mandates

Idaho: State lawmakers have subverted the will of Idaho voters — who approved of a ballot initiative in 2018 to expand Medicaid to adults in the state — by seeking federal approval to put in place a work reporting requirement that will endanger the coverage of Idahoans. Under the bill, all non-disabled, non-elderly adults would be required to work or participate in a work/volunteer program for 20 hours/week or else lose Medicaid eligibility. Idaho previously estimated 18% of Idahoans who gained access to Medicaid when it expanded — 16,300 people — would lose their health coverage due to these requirements. Rather than uphold voter-championed access to Medicaid, lawmakers instead want to incentivize the expansion population to purchase private insurance through the state’s marketplace. Governor Little signed the bill into law on March 19, 2025, requiring the state to submit and seek federal approval for work reporting requirements. on March 19, 2025, requiring the state to submit and seek federal approval for work reporting requirements.

Shell Bills

Mississippi: In January, lawmakers released two different Medicaid “dummy bills.” With a dummy or “shell” bill, lawmakers put forward a near-empty piece of legislation—with no text to explain its intended contents and no transparency to the public. Lawmakers can move these scant bills quickly without resistance, since there is no text to debate. In Mississippi’s case, the dummy bills contained language from the state’s current Medicaid statute, but no changes or additions to the text. One bill died in conference, and the other was ultimately vetoed by the Governor. The secretive process left the Mississippi public unaware of whether lawmakers were debating work reporting requirements (or other harmful proposals) and unable to best advocate for Medicaid improvements in their state.

As state legislatures across the country wrap up their legislative sessions, advocates should be watchful of eleventh-hour maneuvering and other tactics that undermine the will of voters and suppress political and public debate.

Advocates, your voices and vigilance are more critical than ever. Families USA is here to support the tracking of work reporting requirement bills across states. If you would like to connect for resources and/or support, email us!

Medicaid is a lifeline for millions, and together, we can hold lawmakers accountable and defend the program from these relentless attacks.

Send a letter to your representative and demand they protect Medicaid!