New Medicaid Work Rules Likely to Hit Middle-Aged Adults Hard

Concerns over coverage losses and impacts on physical and financial health

Published on Feb. 16, 2026

Got story updates? Submit your updates here. ›

The article discusses how new Medicaid work requirements set to take effect in 2027 are likely to disproportionately impact middle-aged adults, particularly women, who face challenges such as deteriorating health, caregiving responsibilities, and difficulty finding steady employment. Experts warn the rules could result in millions losing Medicaid coverage, putting their physical and financial wellbeing at risk.

Why it matters

The Medicaid work requirements are part of a GOP budget law that aims to reduce Medicaid spending, but critics argue it will come at the expense of people's lives and health. Middle-aged adults, especially women, are more likely to face barriers to meeting the 80-hour monthly work or activity requirement due to health issues, caregiving duties, and employment challenges. Losing Medicaid coverage could have severe consequences for this population.

The details

Starting in January 2027, some 20 million low-income Americans in 42 states and Washington, D.C. will need to meet new Medicaid work requirements to gain or keep their coverage. The rules exempt certain groups like the disabled, pregnant women, and those facing hardship, but experts say many middle-aged adults will still struggle to comply. Women ages 50-64 on Medicaid are more likely to face challenges keeping their coverage due to health problems and caregiving responsibilities that limit their ability to work the required hours. The nonpartisan Congressional Budget Office predicts the work rules will result in at least 5 million fewer people with Medicaid coverage over the next decade.

  • The new Medicaid work requirements are set to take effect in January 2027.
  • The GOP budget law that included the work rules was signed into law in 2026.

The players

Lori Kelley

A 59-year-old resident of Harrisburg, North Carolina who has struggled to find steady work due to deteriorating vision and relies on Medicaid to cover her health needs.

Jennifer Tolbert

The deputy director of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit.

Jane Tavares

A gerontology researcher at the University of Massachusetts Boston.

Andrew Nixon

A spokesperson for the Department of Health and Human Services.

Paula Wallace

A 63-year-old resident of Chidester, Arkansas who is the full-time caregiver for her husband with advanced cirrhosis.

Got photos? Submit your photos here. ›

What they’re saying

“I'm scared right now.”

— Lori Kelley (dailyfly.com)

“We're talking about saving money at the expense of people's lives. The work requirement is just a tool to do that.”

— Jane Tavares, Gerontology researcher, University of Massachusetts Boston (dailyfly.com)

“Requiring 'able-bodied adults' to work ensures Medicaid's 'long-term sustainability' while safeguarding it for the vulnerable.”

— Andrew Nixon, Department of Health and Human Services spokesperson (dailyfly.com)

“With me being his only caregiver, I can't go out and work away from home.”

— Paula Wallace (dailyfly.com)

What’s next

Federal officials have yet to issue specific guidance on how to define the exemption for full-time caregivers, leaving many unsure if they will qualify.

The takeaway

The new Medicaid work requirements threaten to strip coverage from vulnerable middle-aged adults, particularly women, who face significant barriers to meeting the hourly work or activity mandate due to health issues, caregiving responsibilities, and employment challenges. Experts warn this could have severe consequences for the physical and financial wellbeing of this population.