The Impact of Proposed Federal Medicaid Work Requirements on Hospital Revenues and Financial Margins

Commonwealth Fund September 18, 2025
Randy Haught, Akeiisa Coleman, Allen Dobson, Carson Richards, Collin McGuire

TOPLINES

Introducing federal Medicaid work requirements for enrollees in the ACA’s Medicaid expansion will lead to coverage losses that will reduce hospital revenues, increase uncompensated care costs, and lower operating margins.

These adverse outcomes will affect not only Medicaid patients but the communities served by these hospitals.

Abstract

• Issue: Analyses of mandatory federal work requirements for Americans covered by the Affordable Care Act’s Medicaid eligibility expansion have focused on potential coverage losses, overlooking the financial impact on health care providers.
• Goal: To assess the financial impact of the work requirement policy on hospitals in affected states.
• Methods: We used Urban Institute estimates of coverage losses to project the financial impact on acute-care hospitals.
• Key Findings and Conclusion: Hospitals in...

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