Work Reporting Requirements: Bad at Improving Employment Outcomes, Great at Making People Sick and Hungry

Updated with new information on Friday, June 27.

Congress is proposing a massive expansion of so-called work requirements for SNAP and Medicaid benefits through their federal budget bill. These changes are designed to remove millions of people from critical programs in order to pay for tax cuts for millionaires and corporations.  

The proposals create arbitrary requirements and burdensome paperwork that are costly for states and confusing for participants. Most people enrolled in SNAP and Medicaid who can work already do, and the evidence shows that expanding existing work reporting requirements doesn’t lead to more employment — it just means that more people will go hungry and won’t get the health care they need.

What’s in the proposals? 

Congressional budget proposals would force hundreds of thousands of North Carolinians to navigate harsh new work reporting requirements or lose food assistance and health care coverage. This table will be updated as new information about proposals is available. After the Senate votes on their version of the bill, Congress is expected to vote on a final bill as early as the end of June 2025.

Expensive bureaucracy, not better outcomes 

Implementing work reporting requirements will burden states with massive administration costs. State agencies and Managed Care Organizations (MCOs are commercial insurance companies contracted by states to manage aspects of the Medicaid system) must monitor compliance and work hours, process exemption requests, and conduct needed outreach – all of which require more staffing and new computer systems. MCOs taking on these costs will in turn request higher payments from the state. 

• States that submitted plans for Medicaid work requirements during the first Trump administration had administrative costs ranging from $6 million (New Hampshire) to $276 million (Kentucky).
• In Arkansas, the one state where work reporting requirements for Medicaid briefly took effect in 2018, it cost $24 million for less than one year of implementation.
• Estimates for previous proposals for national work reporting requirements found that $65 billion in administrative costs would be shifted to states – costs the federal government won’t fully cover.

Most people are working — but work reporting ignores labor market realities 

The vast majority of people participating in Medicaid and SNAP who can work, are working.  Data from 2023 show:  

• 2 out of 3 people receiving health care through Medicaid work, and most others have a disability, are in school, or are caregivers. 
• 83 percent of SNAP households  with non-disabled adults and no young children had earnings during the year.  

So why do estimates suggest so many people will lose benefits?  Work reporting requirements don’t accurately reflect people’s work. Unpredictable schedules, no sick or family leave, and job instability are common in low-wage service-sector jobs but don’t fit rigid reporting systems. Reporting requirements add red tape and complexity that cause many people to lose assistance even when they’re working or should receive an exemption.

No increases in employment — just harms to well-being 

There is no evidence that work reporting requirements increase employment or improve job quality.  

• Medicaid work requirements in Arkansas led to 18,000 people losing health care coverage, but didn’t increase employment.
• A Congressional Budget Office analysis of an earlier proposal for federal Medicaid work reporting requirements found that it would have no impact on employment or hours worked.  

These requirements do nothing to address the root causes of unemployment, like access to high-quality skills training, transportation, and affordable child care.  

Losing health care and food assistance will make people sick and hungry 

The evidence is clear that work reporting requirements will lead to significant losses in health care and food assistance.

• When people don’t have access to health care, they are less likely to seek preventative care or treatment for chronic conditions are more likely to get sick, which can lead to more work absences and medical debt.
• When people’s food assistance is taken away, it means missed meals and more hunger, and greater reliance on school meals for children.
• While these policies supposedly target working-age adults, children in their households will also face the harmful impacts of less money for food or their caregivers losing health care.

Policymakers should support people’s well-being, not punish them  

To improve health, nutrition, and employment outcomes, policymakers should remove barriers to health-care coverage and food assistance, not increase them.  Instead of using work reporting requirements to push people off programs, Congress should: 

• Stop tax breaks for the very wealthy and corporations
• Invest in real solutions to the systemic issues facing people with low incomes – affordable health care, living wages, child care, and safe communities 

Let’s build a country where public investments make it possible for every person to thrive and be well – and ensure no one is punished for being poor.