Medicaid Work Requirements Must Include Verification to Prevent Fraud and Gaming
Source: Chris Medrano and Brian Blase. "Medicaid Work Requirements Need Real Enforcement." May 26, 2026. thefederalist.com
The Gist
The authors argue that when states implement new Medicaid work requirements, they shouldn't just let people check a box saying they qualify - they need to verify it with real documentation. They point to recent problems where letting people self-report led to massive fraud in other health programs.
Conclusion
States implementing Medicaid work requirements must require documentation and verification rather than allowing self-attestation to prevent widespread fraud and improper enrollment
Premises
- Self-attestation in government programs leads to widespread improper enrollment and fraud, as demonstrated by ACA enrollment issues
- When Biden administration allowed self-attestation for ACA plans in 2024, it resulted in 5 million improper enrollees and $20 billion in improper subsidies
- Louisiana found that 93% of sampled Medicaid enrollees were ineligible when self-reporting was allowed for wage changes
- Multiple parties have financial incentives to maximize Medicaid enrollment regardless of eligibility (applicants, insurers, providers, brokers)
- Work requirements are supported by over 80% of Americans and are essential for upward mobility and protecting vulnerable populations
- Documentation requirements for medical exemptions are feasible because Medicaid provides retroactive coverage and states must give advance notice
Assumptions
- People will lie or misrepresent their circumstances when financial incentives exist and verification is weak
- Government programs require active oversight and verification to maintain integrity
- Work requirements serve legitimate policy goals beyond cost savings
- The costs of verification are justified by the benefits of preventing fraud