Medicaid Work Requirements Reduce Coverage, Don’t Boost Work

Todd Epp spots research comparing Medicaid expansion in South Dakota and Georgia. South Dakota launched Medicaid expansion without a work requirement; Georgia imposed a work requirement.

The work requirement had its expected effect, reducing the number of people covered by Medicaid:

South Dakota’s traditional Medicaid expansion without work requirements resulted in significantly higher coverage gains than Georgia’s Pathways to Coverage program with mandatory work requirements during the first 15 months of implementation, according to a study published Monday in The BMJ.

The research compared Georgia’s approach with South Dakota, which expanded Medicaid on the same date — July 1, 2023 — but without imposing work mandates. Medicaid coverage increased in South Dakota from 36.6 percent to 44.6 percent among low-income adults, while Georgia’s coverage decreased from 35.5 percent to 32.4 percent, resulting in an 11.7 percentage point differential decrease in Georgia relative to South Dakota, according to the study [Todd Epp, “South Dakota’s Medicaid Expansion Significantly Outperformed Georgia’s Work Requirement Model, New Study Shows,” Northern Plains News, 2025.10.09].

The work requirements in Georgia also failed to produce more work, while South Dakota’s more generous Medicaid expansion appears not to have dampened our eagerness to work:

Neither Georgia nor South Dakota showed employment increases compared to control states, with no differential change in employment between the two states, challenging the premise that work requirements promote job participation, the researchers found [Epp, 2025.10.09].

King Donald’s national work requirement for Medicaid is coming, but this research requires us to ask, why? Work requirements don’t boost work; they only deny our neighbors health coverage and care.