Health Care

Medicaid work requirements make moral and fiscal sense

Jonathan Small | July 21, 2025

“Work” may be a four-letter word, but it’s not an obscenity. You wouldn’t know that based on the reaction of many liberals to the new work requirements for Medicaid.

To stay on Medicaid, the new law requires able-bodied adults with no children to spend only 80 hours per month either working, going to school, participating in a work program, or doing community service.

If you’re thinking, “That doesn’t seem too hard,” you’re right. To suggest these extremely lenient work requirements are draconian is nonsense.

Many able-bodied adults added to Medicaid through Obamacare expansion are capable of working, but do not.

Kevin Corinth, a senior fellow at the American Enterprise Institute, has estimated that between 40 percent and 56 percent of childless, non-disabled Medicaid recipients age 19–64 would not have been in compliance with the work requirements in 2022.

Corinth examined data from the American Time Use Survey (ATUS) and the Current Population Survey Annual Social and Economic Supplement (CPS ASEC).

One scholar found that able-bodied, childless adults on Medicaid spent 4.2 hours per day watching television and playing video games.

He found that able-bodied, childless adults on Medicaid spent 4.2 hours per day watching television and playing video games, or 125 hours during a 30-day month. They spend on average 6.1 hours per day, or 184 hours per month on all socializing, relaxing, and leisure activities. 

In contrast, those individuals spent only about 22 minutes looking for work, four hours doing housework and errands, and 28 minutes caring for others.

As many others have quipped, how is it unconscionable to ask able-bodied adults to work (or volunteer) part-time to receive Medicaid, but fine to expect everyone else to work full time to pay the taxes that fund Medicaid?

Work requirements will ultimately reduce taxpayer costs because those who work quickly reach the point where they don’t need taxpayer assistance. And Oklahoma needs to reduce its exploding Medicaid costs before they force major cuts to other, more important needs, such as education, roads, and public safety.

How is it unconscionable to ask able-bodied adults to work in order to receive Medicaid—but just fine to expect everyone else to work to pay the taxes that fund Medicaid?

In 2021, the year Medicaid expansion took effect in Oklahoma, the state Medicaid program spent $5.99 billion. By 2024, total spending had surged to $10.3 billion.

An April report from the Oklahoma Health Care Authority shows that 229,154 able-bodied adults in Oklahoma are currently on Medicaid.

More importantly, work requirements are most beneficial for the people subjected to them. Why? Because work brings dignity and self-respect. It provides upward mobility. It allows people to have purpose, even if their personal budgets are tight.

In the 1990s, work requirements were imposed on food-stamp recipients. Opponents predicted calamity. It never happened. Instead, work requirements were soon hailed as a major, bipartisan success.

With Medicaid work requirements, it appears history is poised to repeat itself.

Jonathan Small President

Jonathan Small

President

Jonathan Small, C.P.A., serves as President and joined the staff in December of 2010. Previously, Jonathan served as a budget analyst for the Oklahoma Office of State Finance, as a fiscal policy analyst and research analyst for the Oklahoma House of Representatives, and as director of government affairs for the Oklahoma Insurance Department. Small’s work includes co-authoring “Economics 101” with Dr. Arthur Laffer and Dr. Wayne Winegarden, and his policy expertise has been referenced by The Oklahoman, the Tulsa World, National Review, the L.A. Times, The Hill, the Wall Street Journal and the Huffington Post. His weekly column “Free Market Friday” is published by the Journal Record and syndicated in 27 markets. A recipient of the American Legislative Exchange Council’s prestigious Private Sector Member of the Year award, Small is nationally recognized for his work to promote free markets, limited government and innovative public policy reforms. Jonathan holds a B.A. in Accounting from the University of Central Oklahoma and is a Certified Public Accountant.

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