Medicaid Work Requirements: Engaging Clinics and Pharmacies to Prevent Disenrollment

Background/Policy Context: The One Big Beautiful Bill Act, enacted on July 4, 2025, established the first nationwide Medicaid work requirement, replacing prior state-specific Section 1115 demonstrations with a uniform federal standard. Historical evidence from welfare programs and Medicaid pilots, particularly in Arkansas, suggests that while work or community engagement requirements may have moderate public support, poorly designed reporting systems and administrative barriers can lead to substantial procedural disenrollment without measurable employment gains.

Policy Proposal: This perspective outlines a framework for leveraging high-touch health care settings—primary care clinics and community pharmacies—to facilitate verification of work or community engagement hours. These sites already maintain frequent contact with Medicaid beneficiaries, have established billing relationships with Medicaid, and can provide physical access points that mitigate digital-access disparities. Policy options for provider compensation include fee-for-service payments per verification or capitated per-member-per-month arrangements.

Policy Implications: By integrating verification into trusted, accessible care settings, states can reduce administrative burden, preserve coverage for eligible beneficiaries, and align One Big Beautiful Bill Act’s implementation with program integrity goals.