Early findings on the impact of Medicaid work requirements

On 4 July 2025, President Trump signed a budget reconciliation package that included major changes to Medicaid: all states that have adopted the Affordable Care Act’s Medicaid expansion will need to implement work requirements for enrollees covered under the expansion by 1 January 2027. As the only state with an active Medicaid work requirement in 2025, Georgia’s Pathways to Coverage program is a clear antecedent for this aspect of the “Big Beautiful Bill.” But what do we know about how the program is working in Georgia?In a linked study, Johnson and colleagues (doi:10.1136/bmj-2025-086792) evaluated the impact of Georgia’s Pathways to Coverage program.1 Pathways to Coverage is one of dozens of state Medicaid demonstration projects authorized by the Centers for Medicare and Medicaid Services (CMS) as part of the Section 1115 waiver program. Using data from the US Census Bureau’s household pulse survey, the authors compared Georgia with neighboring non-expansion states…