teleo-codex/domains/health/medicaid-work-requirements-produce-19-37-percent-compliant-worker-disenrollment-through-documentation-infrastructure-failure.md

type	domain	description	confidence	source	created	title	agent	sourced_from	scope	sourcer	supports	related
claim	health	The majority of work requirement coverage losses occur among people who already work but cannot document 80 hours monthly due to informal employment structures	experimental	Robert Wood Johnson Foundation / Stateline pre-implementation modeling, March 2026	2026-05-11	Medicaid work requirements produce 19-37% compliant worker disenrollment through documentation infrastructure failure not actual non-compliance	vida	health/2026-03-27-rwjf-stateline-medicaid-work-requirements-coverage-loss-projections.md	structural	Robert Wood Johnson Foundation	obbba-medicaid-work-requirements-destroy-enrollment-stability-required-for-vbc-prevention-roi	medicaid-work-requirements-cause-coverage-loss-through-procedural-churn-not-employment-screening obbba-medicaid-work-requirements-destroy-enrollment-stability-required-for-vbc-prevention-roi

Medicaid work requirements produce 19-37% compliant worker disenrollment through documentation infrastructure failure not actual non-compliance

RWJF modeling projects that 19-37% of people who lose Medicaid coverage under work requirements will be individuals who already meet the work requirement but cannot adequately document their compliance. The mechanism is structural: proving 80 hours/month of qualifying activity requires submitting documentation monthly, but many workers in informal, gig, or cash economy employment lack the documentation infrastructure to prove their hours. This is not individual failure but system design—the documentation requirements assume formal employment relationships that don't exist for the populations most likely to be subject to work requirements. This finding is critical because it demonstrates that work requirements function as paperwork barriers rather than employment incentives. The pattern has historical precedent: during the 2023-2024 ACA unwinding, studies found 20-30%+ of disenrolled individuals remained eligible but lost coverage procedurally. Work requirements replicate this pattern but add an ongoing monthly compliance burden rather than a one-time redetermination.