Louisiana now has a count of who is at risk.

As many as 58,000 Louisianans on Medicaid may have to take extra steps to keep their health coverage when the new federal work requirements start in January, the Louisiana Illuminator reported. The number came from the state health department, in a packet it handed state lawmakers at a budget committee meeting on Thursday.

Those rules come from Trump's budget bill. Every Republican who represents Louisiana in the House voted for that bill, and all four voted for it twice: Mike Johnson, the Speaker of the House; Steve Scalise, the House Majority Leader; Clay Higgins; and Julia Letlow, who is now running for the U.S. Senate.

What the rules demand

Starting in January, Louisianans between the ages of 19 and 65 who don't qualify for an exemption will have to show they earn at least $580 a month, or work or volunteer at least 80 hours a month, to keep Medicaid. Going to school or job training part-time also counts.

The state's breakdown shows who is most exposed:

• About 46,000 Medicaid recipients have no exemption and no income at all. They are the most likely to have to change something to keep their coverage.
• Another 12,000 earn some money each month, but not enough to meet the $580 line.
• About 80,000 already meet the rule through their current job. The Illuminator notes those jobs are low-paying.

Some of those 58,000 may already meet the rule through school, job training or volunteering. It isn't clear how many yet: the health department hasn't started tracking those activities.

Most of Louisiana's 1.3 million Medicaid enrollees, about 1.1 million, will get an automatic exemption, including parents and caregivers of dependent children, people with disabilities, and pregnant and postpartum women. The people left facing the rule are the ones in the breakdown above: people with no income, and people whose paychecks come up short.

This is what they voted for

The work rules are only one piece. Louisiana stands to lose an estimated $21.9 billion in federal Medicaid dollars, and as much as $27.4 billion, over the next decade under the law, KFF estimates. KFF also projects that more than 200,000 Louisianans would be uninsured by 2034 because of the Medicaid cuts; counting marketplace coverage, a Commonwealth Fund researcher put it as high as 300,000.

The House roll calls show how Louisiana's delegation split:

• On May 22, 2025, the House first passed the bill. Mike Johnson, Steve Scalise, Clay Higgins and Julia Letlow voted yes. Louisiana's two Democrats voted no.
• On July 3, 2025, the House passed the final version that became law. All four voted yes again. Both Democrats voted no again.

Johnson and Scalise didn't just vote for it. As the top two Republicans in the House, they were the ones who got it passed.

Johnson's own district

Medicaid is not a small program where Johnson lives. Nearly 290,000 people in his district, about 38% of the population, were on Medicaid in 2024, KFF Health News reported.

In February 2025, when he pushed a House budget plan calling for at least $880 billion in cuts from a pool of money that includes Medicaid, Johnson defended it by saying Medicaid is "not for 29-year-old males sitting on their couches playing video games."

His own state's numbers don't describe that. They describe 46,000 people with no income and a new rule to meet, and 12,000 more who are working but not earning enough to clear the bar he voted for.

It's the same pattern we've seen elsewhere. In Colorado, Jeff Hurd promised in writing he wouldn't cut Medicaid, then voted for the same law twice.

What the record shows

Mike Johnson, Steve Scalise, Clay Higgins and Julia Letlow each voted twice for Trump's budget bill, and Johnson and Scalise led it through the House. Louisiana's health department now says as many as 58,000 Medicaid recipients may have to take extra steps to keep their coverage when its work requirements begin in January, including about 46,000 with no income at all. The health department hasn't started tracking the school, training and volunteer hours that could keep some of them covered.

Source

This post is based on reporting by Julie O'Donoghue for the Louisiana Illuminator. Photo: John Partipilo/Tennessee Lookout, via the Louisiana Illuminator.