On January 1, the Medicaid work requirements Republicans wrote into Trump's budget bill take effect across the country. Many adults on Medicaid will have to prove that they work, volunteer or go to school 80 hours a month.

Many of the people who lose coverage won't lose it because they don't work. They'll lose it because of the paperwork. And somebody is getting paid to run that paperwork.

Who loses

The Congressional Budget Office expects about 7.5 million people to lose their coverage by 2034 under the law, Mother Jones reports. At least 2.6 million of them will lose it not because they are ineligible, but because proving it is too hard.

A new report from Democratic members of the Senate Finance Committee — Sens. Ron Wyden, Elizabeth Warren and Raphael Warnock — put it plainly: "These are not people who failed to qualify—they are eligible Americans who will be stripped of coverage because they could not navigate a system designed to pile on paperwork, not to protect care."

The same budget bill cuts almost $1 trillion from Medicaid over ten years.

Who gets paid

States have to build systems to check every enrollee's hours. Many of them are hiring outside companies to do it. The senators' report looked at five of the biggest: Deloitte, Maximus, Gainwell, General Dynamics and Conduent.

These are not new names. A year ago, the same senators pressed Deloitte and other contractors about errors in the Medicaid eligibility systems they already run for states, after a KFF Health News investigation.

• Gainwell Technologies, owned by the private equity firm Veritas Capital, holds Medicaid contracts with at least 43 states. It launched a "work requirements verification solution" in October 2025. A New York State Comptroller audit found a Gainwell subsidiary had not billed private insurers for about $52.2 million in hospital claims that Medicaid managed care plans paid instead.
• Deloitte was the main contractor behind Georgia's Medicaid eligibility system.

The senators asked the companies to show their contracts, to see whether the states had built in any reason for them to get it right. According to the report, "no vendor provided their contracts to the committee."

Georgia already ran the experiment

Georgia already has Medicaid work requirements, under Gov. Brian Kemp's "Pathways" program, which started in 2023. Here is how it went, according to Mother Jones:

• Two years in, only about 8,077 Georgians were enrolled — roughly 7% of the people who could have qualified.
• The state spent about $54 million on administration — more than double the $26 million it spent actually insuring people.
• Another $27 million went to consultants to set it up.

Arkansas tried work requirements in 2018. About 17,000 people lost coverage in four months.

In other words, the paperwork cost more than twice as much as the health care. We've already reported that Georgia now says it can't afford Kemp's program because of the budget bill every Georgia Republican in the House voted for.

The point of the paperwork

Republicans sold work requirements as a way to get people working. In Arkansas, they knocked 17,000 people off coverage in four months. In Georgia, barely 7% of the people who could have qualified ended up enrolled. And the companies that run the checks get paid to run them.

People who lose their coverage "will come in sicker, and they'll come in later," Minnesota State Sen. Matt Klein said, as quoted by Mother Jones.

The rules were written into law by Republicans. Rep. Aaron Bean of Florida, for one, wrote the bill that became the work requirements — twice.

What the numbers show

Starting January 1, the Medicaid work requirements in Trump's budget bill will force adults to document 80 hours a month, and the Congressional Budget Office expects about 7.5 million people to lose coverage by 2034 — at least 2.6 million of them eligible people tripped up by paperwork. States are paying contractors like Deloitte and Gainwell to run the checks, and none of the five companies the Senate report examined handed over their contracts. In Georgia, which already has work requirements, administration cost $54 million, more than double the $26 million spent covering people.

Source

Mother Jones: Private Contractors Are Set to Cash In As Millions of Americans Lose Health Care