With just over a year to go until low-income people covered by Medicaid expansion in 40 states must start verifying they’re working, or exempt from work requirements, a University of Michigan health care researcher says there isn’t a moment to waste.
Writing in the New England Journal of Medicine , John Z. Ayanian, M.D., M.P.P., lays out key actions that states, health care providers and organizations, community groups and researchers should take to keep people from losing Medicaid coverage if they actually qualify.
Ayanian heads the U-M Institute for Healthcare Policy and Innovation and its team evaluating the expansion of Medicaid in Michigan under the Healthy Michigan Plan.
He wrote the new piece in response to the Medicaid-related components of the One Big Beautiful Bill Act (OBBBA), signed into law in July 2025. Most states will have to comply by January 2027.
For example, he writes:
In his piece, Ayanian also lays out some key facts about Medicaid and its enrollees, including Census data about what percentage are already working even in the absence of work requirements (44% full time, 20% part time), and what percentage are caregiving (12%), attending school (7%), retired or unable to find work (8%) or too ill or disabled to work (10%).
To qualify for Medicaid in the 40 states and the District of Columbia that have expanded eligibility and are subject to the OBBBA’s work requirement rules, a person can make no more than 138% of the federal poverty level.
That’s about $21,600 a year for an individual, while a couple can make no more than $29,187 a year, and a family of four can have an income of no more than $44,367 a year. That works out to a wage of about $10.40 an hour for someone working 40 hours a week every week of the year.
To learn more about U-M research on Medicaid, and the evaluation of the Healthy Michigan Plan, visit https://ihpi.umich.edu/informing-policy/medicaid
An audio interview with Ayanian will be available on the NEJM website on September 17.
Citation: Protecting Medicaid Enrollees with Chronic Conditions amid Work Requirements, New England Journal of Medicine , DOI: 10.1056/NEJMp2508966, https://www.nejm.org/media/doi/full/10.1056/NEJMp2508966
New England Journal of Medicine
Commentary/editorial
People
Protecting Medicaid Enrollees with Chronic Conditions amid Work Requirements
13-Sep-2025