The Argument for Legal Advocacy Amidst New Medicaid Requirements
The “One Big Beautiful Bill” Act, signed into law on July 4, 2025, brings about significant changes to Medicaid, the Affordable Care Act (ACA), and the Supplemental Nutrition Assistance Program (SNAP). These changes include new Medicaid work requirements that could make it more challenging for individuals to maintain their healthcare coverage. 1.
Medicaid Requirements Under the Big Beautiful Bill
The “One Big Beautiful Bill” introduces several changes to Medicaid, including work and community service requirements. While proponents may argue these requirements encourage self-sufficiency, research indicates that the majority of Medicaid enrollees who are able to work are already employed. These new requirements are poised to create a complex and potentially hostile environment for many, making the need for strong legal advocates and civil legal aid more critical than ever.
The proposed Medicaid work requirements are designed to deny coverage unless individuals can prove they are working, even before enrollment. This could severely impact those transitioning between jobs, facing reduced hours, or recovering from illness or surgery. The bill’s provisions are more stringent than previous state waivers, which have already shown to result in significant coverage losses. 2. For instance, a similar policy implemented in Arkansas in 2018 led to over 18,000 people, approximately one in four subject to the requirement, losing coverage, and employment did not increase. 3.
A significant concern is the potential for confusion and unfair denials under these new rules. States could require monthly reporting of work activity, posing challenges for gig workers, shift workers whose managers change schedules, or seasonal employees. 4. Missing even a week or two of work because of illness or a family emergency could result in loss of health insurance. Furthermore, the bill would also bar individuals from discounted healthcare through the Marketplace if they lose Medicaid due to work requirements.
The Argument for Legal Advocacy Amidst New Medicaid Requirements
Exemption processes, intended for those unable to work based on disability, pregnancy, caregiving, age, or other factors, have historically been confusing, poorly publicized, and riddled with paperwork and red tape. Many eligible individuals, including those with disabilities, lost coverage in Arkansas because the exemption process was so broken. The new bill’s requirements are expected to be even more extreme. States would not have to provide leniency for people transitioning between health care settings or who experience a sudden health emergency. There’s no grace period for someone who gets sick and is unable to file paperwork. States could even require people to prove they’ve worked for months or even years before they’re allowed to apply for coverage in the first place. Missing a month could reset the clock.
In this increasingly complex landscape, civil legal aid attorneys and allied legal professionals will be essential. They can help individuals navigate confusing requirements, understand their rights, determine if they qualify for exemptions, and appeal unfair denials of coverage. When the social safety net becomes tangled with bureaucratic hurdles and punitive measures, legal advocates can serve as a vital lifeline, ensuring that vulnerable populations retain access to the healthcare they need.
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