As of January 1, 2027, millions of Medicaid beneficiaries will face stringent new requirements under the controversial healthcare reform law known as HR 1, signed by Donald Trump on July 4, 2025. This legislation mandates that recipients must demonstrate they are working at least 80 hours per month, a change that has raised alarms among healthcare providers and patient advocates alike.

Background on HR 1

The American Academy of Pediatrics president, Dr. Andrew Racine, emphasized the potential societal costs of these changes, stating, "The costs to the family – and society as a whole – cannot be overstated." The law is expected to cut approximately $1 trillion in federal spending from the healthcare sector, marking the largest reduction in federal health spending to date. This is anticipated to leave about 17 million individuals uninsured by 2034.

According to the Centers for Medicare and Medicaid Services (CMS), nearly half of all health spending in the U.S. is funded by government programs, with Medicare and Medicaid accounting for about 40% of health expenditures in 2024. In that year alone, Medicaid expenditures reached $937 billion.

Implications for Medicaid Recipients

The new work requirements will primarily affect individuals in the 44 states that expanded Medicaid under the Affordable Care Act (ACA). Approximately 20 million people will need to prove their employment status, education, or volunteer work to maintain their eligibility. Additionally, they will be required to re-certify their eligibility every six months instead of annually.