House Republicans Unveil Medicaid Overhaul Plan: Work Requirements and Eligibility Checks Take Center Stage

House Republicans have released a comprehensive plan to reshape the Medicaid program, focusing on implementing work requirements and stricter eligibility verification measures. The proposal, drafted by the House Energy and Commerce Committee and unveiled late on May 11th, is expected to be a key component of the Republican’s broader legislative package aimed at enacting President Donald Trump’s agenda.

The plan seeks to achieve substantial savings within the Medicaid program, though it steers clear of some of the more drastic measures previously considered, such as reducing federal matching rates with states or imposing per-person federal spending caps. The committee was tasked with identifying $880 billion in savings, a challenging objective given Trump’s stated opposition to cuts in Medicare and Social Security, leaving Medicaid as the primary target for fiscal adjustments.

The proposed changes are seemingly designed to appeal to moderate Republicans who have expressed reservations about making significant alterations to the program, which provides health insurance to over 71 million low-income Americans. By focusing on work requirements and eligibility verification, the plan attempts to address concerns about program integrity and incentivize beneficiaries to seek employment.

However, the approach is expected to face resistance from both ends of the political spectrum. Conservative Republicans may argue that the proposal does not go far enough in reforming the program and reducing federal spending. Committee Chairman Brett Guthrie, R-Kentucky, acknowledged this potential opposition, anticipating that some Republicans will feel the plan falls short of achieving the desired level of fiscal discipline. This sets the stage for a potential clash between moderate and conservative factions within the Republican party, particularly as they seek to craft a final tax package that balances revenue and spending.

The plan includes several specific provisions that are likely to generate debate and controversy. One key element is the proposal to mandate work requirements for certain Medicaid beneficiaries. This would require individuals to demonstrate that they are employed, actively seeking work, or participating in job training programs in order to maintain their Medicaid eligibility. The specifics of these work requirements, including the number of hours required and exemptions for certain populations, would likely be determined by the states, subject to federal approval.

Another significant aspect of the proposal is the emphasis on more frequent and rigorous eligibility checks. This aims to ensure that individuals who are enrolled in Medicaid are truly eligible for the program and that they continue to meet the eligibility requirements. The plan could involve more frequent income verification, asset checks, and residency verification measures.

In addition to these core provisions, the Republican plan also includes measures targeting specific areas of concern. It proposes to bar the use of Medicaid and CHIP funding for gender transition procedures for individuals under the age of 18. This provision is likely to spark heated debate, with opponents arguing that it discriminates against transgender youth and denies them access to essential healthcare services.

The plan also seeks to lower the federal matching rate for states that utilize their Medicaid infrastructure to provide healthcare to undocumented immigrants. This provision reflects the Republican’s broader efforts to restrict access to public benefits for undocumented individuals and to discourage states from providing them with healthcare services.

Another proposal would reduce cost-sharing for Medicaid Expansion patients who earn more than the federal poverty level, which is currently $32,150 for a family of four. This provision aims to address concerns about affordability for individuals who have gained Medicaid coverage through the Affordable Care Act’s expansion of the program.

The plan also incorporates a provision that would require individuals to verify their citizenship, nationality, or immigration status in order to be eligible for Medicaid. This measure is consistent with the Republican’s broader efforts to strengthen immigration enforcement and to ensure that only eligible individuals receive public benefits.

The exact amount of savings that would be achieved through these proposed changes remains unclear. The committee will convene on Tuesday to further consider the legislation and to assess its budgetary impact.

Any attempts to cut Medicaid spending are certain to face strong opposition, not only from Democrats but also from some Republicans. Sen. Josh Hawley, R-Mo., recently argued that cuts to Medicaid are inconsistent with the Trump coalition’s priorities. In a New York Times opinion piece published on May 12, Hawley asserted that working families deserve measures like a cap on prescription drug prices and tax cuts, rather than having their healthcare access reduced.

Congressional Republicans are aiming to finalize their spending package by July 4. However, the looming deadline of early August, when Treasury Secretary Scott Bessent has warned that the United States will likely reach its debt limit, adds urgency to the process.

A central component of the package will be an extension of Trump’s 2017 tax cuts, which are set to expire at the end of the year. The President has also expressed interest in eliminating taxes on tips, overtime pay, and Social Security payments.

Beyond the Medicaid overhaul and tax cuts, the bill is anticipated to roll back several clean energy provisions that were implemented under former President Joe Biden. It is also expected to include increased spending on defense and border security.

Republicans intend to pass the package through a process known as "reconciliation," which allows them to bypass the filibuster in the Senate and avoid the need for Democratic support. This procedural advantage is crucial for ensuring the bill’s passage, given the deep partisan divisions in Congress. However, it also means that the bill is likely to be highly controversial and subject to intense scrutiny.