KFF Health News: Impact of New Medicaid Work Rules on Middle-Aged Adults
February 11, 2026
KFF Health News: New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard
Lori Kelley, a 59-year-old resident of Harrisburg, North Carolina, faces significant challenges due to her deteriorating vision, which has hindered her ability to secure steady employment. After closing her nonprofit circus arts school last year, she briefly worked at a pizza shop before taking on her current job sorting recyclable materials at a local concert venue. This job, while meaningful, is not year-round and constitutes her primary source of income.
“This place knows me, and this place loves me,” Kelley expressed, referring to her employer. “I don’t have to explain to this place why I can’t read.” Living in a camper and surviving on less than $10,000 annually, Kelley relies heavily on her Medicaid health coverage, which helps pay for essential medications for arthritis and anxiety, as well as doctor visits for managing high blood pressure.
However, Kelley is anxious about losing her coverage next year due to new rules that will require millions of individuals like her to work, volunteer, attend school, or engage in other qualifying activities for at least 80 hours each month. “I’m scared right now,” she admitted.
Prior to the enactment of these coverage changes, Republican lawmakers suggested that young, unemployed men were exploiting the Medicaid program, which is designed for low-income or disabled individuals. House Speaker Mike Johnson stated that Medicaid is not meant for “29-year-old males sitting on their couches playing video games.”
In reality, adults aged 50 to 64, particularly women, are expected to be disproportionately affected by these new rules. Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, noted that the work requirements will create barriers for many, potentially leading to loss of Medicaid coverage and jeopardizing their physical and financial health.
Starting next January, approximately 20 million low-income Americans across 42 states and Washington, D.C., will need to meet these activity requirements to maintain their Medicaid health coverage. States like Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming, which did not expand their Medicaid programs under the Affordable Care Act, will not be subject to these new work rules.
The nonpartisan Congressional Budget Office predicts that these work requirements could lead to at least 5 million fewer individuals having Medicaid coverage over the next decade. Critics argue that these rules are a significant factor in the coverage losses outlined in the GOP budget law, which aims to cut nearly $1 trillion to fund tax breaks primarily benefiting the wealthy.
“We’re talking about saving money at the expense of people’s lives,” stated Jane Tavares, a gerontology researcher at the University of Massachusetts Boston. “The work requirement is just a tool to do that.”
According to Andrew Nixon, a spokesperson for the Department of Health and Human Services, requiring “able-bodied adults” to work is essential for ensuring Medicaid’s long-term sustainability while protecting vulnerable populations. Exemptions will apply to individuals with disabilities, caregivers, pregnant and postpartum individuals, veterans with total disabilities, and others facing medical or personal hardships.
Medicaid expansion has been a crucial support for middle-aged adults who would otherwise lack insurance. Research from Georgetown University indicates that Medicaid covers 1 in 5 Americans aged 50 to 64, providing essential health coverage before they qualify for Medicare at age 65.
Women aged 50 to 64 on Medicaid face greater challenges in maintaining their coverage compared to their younger counterparts, as they often have higher healthcare needs and may not meet the required work hours due to caregiving responsibilities or health issues. Tavares and other researchers found that only 8% of the total Medicaid population is considered “able-bodied” and not working, with many in this group being women who have left the workforce to care for family members.
“They are not healthy young adults just hanging out,” the researchers emphasized. Moreover, making it more difficult for individuals to retain Medicaid coverage could exacerbate their health issues, leading to untreated chronic conditions.
Many adults begin experiencing health challenges before they reach Medicare eligibility. If older adults cannot afford to address these issues prior to age 65, they may face more severe health problems when they finally qualify for Medicare, ultimately increasing costs for the program.
Caregiver advocates highlight that many adults in their 50s and early 60s are not working because they are full-time caregivers for children or elderly family members, often referred to as the “sandwich generation.” While the GOP budget law allows for some caregiver exemptions from the Medicaid work rules, these provisions are described as “very narrow,” raising concerns that eligible individuals may fall through the cracks.
“You’re going to see family caregivers getting sicker, continuing to forgo their own care, and then you’re going to see more and more families in crisis situations,” warned Nicole Jorwic, chief program officer for Caring Across Generations.
Paula Wallace, a 63-year-old from Chidester, Arkansas, has spent her life working but now dedicates her time to caring for her husband, who suffers from advanced cirrhosis. After years without insurance, she recently gained coverage through her state’s Medicaid expansion, but the new work requirements pose a significant challenge for her. “With me being his only caregiver, I can’t go out and work away from home,” she explained.
Although Wallace should qualify for an exemption as a full-time caregiver, federal officials have yet to provide clear guidance on how to define this exemption. Past experiences from Arkansas and Georgia, the only states to have implemented Medicaid work programs, indicate that many enrollees struggle to navigate complex benefits systems.
“I’m very concerned,” Wallace expressed.
By Samantha Liss and Sam Whitehead
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
February 11, 2026
KFF Health News: New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard
Lori Kelley, a 59-year-old resident of Harrisburg, North Carolina, faces significant challenges due to her deteriorating vision, which has hindered her ability to secure steady employment. After closing her nonprofit circus arts school last year, she briefly worked at a pizza shop before taking on her current job sorting recyclable materials at a local concert venue. This job, while meaningful, is not year-round and constitutes her primary source of income.
“This place knows me, and this place loves me,” Kelley expressed, referring to her employer. “I don’t have to explain to this place why I can’t read.” Living in a camper and surviving on less than $10,000 annually, Kelley relies heavily on her Medicaid health coverage, which helps pay for essential medications for arthritis and anxiety, as well as doctor visits for managing high blood pressure.
However, Kelley is anxious about losing her coverage next year due to new rules that will require millions of individuals like her to work, volunteer, attend school, or engage in other qualifying activities for at least 80 hours each month. “I’m scared right now,” she admitted.
Prior to the enactment of these coverage changes, Republican lawmakers suggested that young, unemployed men were exploiting the Medicaid program, which is designed for low-income or disabled individuals. House Speaker Mike Johnson stated that Medicaid is not meant for “29-year-old males sitting on their couches playing video games.”
In reality, adults aged 50 to 64, particularly women, are expected to be disproportionately affected by these new rules. Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, noted that the work requirements will create barriers for many, potentially leading to loss of Medicaid coverage and jeopardizing their physical and financial health.
Starting next January, approximately 20 million low-income Americans across 42 states and Washington, D.C., will need to meet these activity requirements to maintain their Medicaid health coverage. States like Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming, which did not expand their Medicaid programs under the Affordable Care Act, will not be subject to these new work rules.
The nonpartisan Congressional Budget Office predicts that these work requirements could lead to at least 5 million fewer individuals having Medicaid coverage over the next decade. Critics argue that these rules are a significant factor in the coverage losses outlined in the GOP budget law, which aims to cut nearly $1 trillion to fund tax breaks primarily benefiting the wealthy.
“We’re talking about saving money at the expense of people’s lives,” stated Jane Tavares, a gerontology researcher at the University of Massachusetts Boston. “The work requirement is just a tool to do that.”
According to Andrew Nixon, a spokesperson for the Department of Health and Human Services, requiring “able-bodied adults” to work is essential for ensuring Medicaid’s long-term sustainability while protecting vulnerable populations. Exemptions will apply to individuals with disabilities, caregivers, pregnant and postpartum individuals, veterans with total disabilities, and others facing medical or personal hardships.
Medicaid expansion has been a crucial support for middle-aged adults who would otherwise lack insurance. Research from Georgetown University indicates that Medicaid covers 1 in 5 Americans aged 50 to 64, providing essential health coverage before they qualify for Medicare at age 65.
Women aged 50 to 64 on Medicaid face greater challenges in maintaining their coverage compared to their younger counterparts, as they often have higher healthcare needs and may not meet the required work hours due to caregiving responsibilities or health issues. Tavares and other researchers found that only 8% of the total Medicaid population is considered “able-bodied” and not working, with many in this group being women who have left the workforce to care for family members.
“They are not healthy young adults just hanging out,” the researchers emphasized. Moreover, making it more difficult for individuals to retain Medicaid coverage could exacerbate their health issues, leading to untreated chronic conditions.
Many adults begin experiencing health challenges before they reach Medicare eligibility. If older adults cannot afford to address these issues prior to age 65, they may face more severe health problems when they finally qualify for Medicare, ultimately increasing costs for the program.
Caregiver advocates highlight that many adults in their 50s and early 60s are not working because they are full-time caregivers for children or elderly family members, often referred to as the “sandwich generation.” While the GOP budget law allows for some caregiver exemptions from the Medicaid work rules, these provisions are described as “very narrow,” raising concerns that eligible individuals may fall through the cracks.
“You’re going to see family caregivers getting sicker, continuing to forgo their own care, and then you’re going to see more and more families in crisis situations,” warned Nicole Jorwic, chief program officer for Caring Across Generations.
Paula Wallace, a 63-year-old from Chidester, Arkansas, has spent her life working but now dedicates her time to caring for her husband, who suffers from advanced cirrhosis. After years without insurance, she recently gained coverage through her state’s Medicaid expansion, but the new work requirements pose a significant challenge for her. “With me being his only caregiver, I can’t go out and work away from home,” she explained.
Although Wallace should qualify for an exemption as a full-time caregiver, federal officials have yet to provide clear guidance on how to define this exemption. Past experiences from Arkansas and Georgia, the only states to have implemented Medicaid work programs, indicate that many enrollees struggle to navigate complex benefits systems.
“I’m very concerned,” Wallace expressed.
By Samantha Liss and Sam Whitehead
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
