On January 1, 2027, adults covered by the Affordable Care Act's Medicaid expansion — in the 41 states that adopted it, Washington, D.C. among them — will have to prove to their state that they worked, volunteered, or went to school for at least 80 hours a month — every month — or lose their health coverage.

Most coverage of that rule treats it as something that happened to Congress. A provision buried in Trump's budget bill. Nobody's fingerprints on it.

Aaron Bean's fingerprints are on it. He filed it as a standalone bill twice, before it was ever in the budget.

The paper trail

On December 6, 2024 — a month before the new Congress was even sworn in — Bean introduced H.R. 10317, "To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program." It got one cosponsor and died.

On February 13, 2025, he filed it again as H.R. 1279, with the identical title and three original cosponsors; a fourth signed on five days later. It went to the Energy and Commerce Committee and has never moved.

The text is short and specific. To keep coverage, a person has to hit 80 hours or more per month of work, community service, a work program, or some combination. There are eight ways out — under 18, over 65, pregnant, unfit for work per a doctor, caring for a child or an incapacitated person, in drug or alcohol treatment, in school at least half time, or already meeting work rules under another program.

And then there's subsection (c), which the bill's title gives no hint of:

State Option To Disenroll Certain Individuals — "Notwithstanding any of the preceding provisions of this subsection, at the option of a State, such State may elect to disenroll an applicable individual for a month if, with respect to medical assistance furnished to such individual for such month, no Federal financial participation would be available, pursuant to section 1903(i)(28)."

Under five months after Bean filed it the second time, the same policy — the same 80 hours, the same "community engagement" language — was written into Trump's budget bill and signed into law.

Bean's version reached further than the law that passed

Here's the part worth understanding.

The requirement that became law applies to one specific group: adults covered through the Affordable Care Act's Medicaid expansion, in the 41 states, D.C. included, that adopted it. It takes effect January 1, 2027.

Bean's bill has no such limit. Its definition of "applicable individual" is simply any Medicaid enrollee who isn't in one of the eight exempt categories. There is no carve-out for people covered through traditional Medicaid, and no carve-out for states that never expanded.

It is worth looking at what that means in Bean's own state. Florida is one of just 10 states that have refused to expand Medicaid. A parent in Florida qualifies for Medicaid only up to 26% of the federal poverty level. A childless adult under 65 who isn't disabled doesn't qualify at any income. About 388,000 Floridians are already stranded in the coverage gap — too poor for marketplace subsidies, too "rich" for Florida Medicaid. Only Texas has more.

So the law Congress passed skips Florida almost entirely, because Florida already refuses to cover the people it targets. Bean's version is not limited to expansion states — but it would reach few Floridians either, because nearly everyone Florida does cover is a parent, pregnant, elderly, or disabled, and every one of those is on Bean's own exemption list. The extra reach he wrote in falls on Medicaid enrollees in other states.

92% of the people this targets are already working

The case for work requirements rests on a picture of Medicaid that isn't true.

KFF looked at adults under 65 on Medicaid, setting aside those getting disability benefits, and found that 92% were working or engaged in other activities: 64% worked full or part-time, 12% weren't working because they were caregiving, 10% because of illness or disability, and 7% because they were in school. The remaining 8% were retired, unable to find work, or not working for some other reason.

So the rule doesn't move many people from not-working to working. It moves people from covered to uncovered — because of paperwork.

We know that because a state already ran the experiment. Arkansas imposed Medicaid work requirements in 2018. Over 18,000 people — about a quarter of everyone subject to the rule — lost coverage between June 2018 and March 2019, and KFF's summary of the research is blunt about the cause: the losses came primarily from "failure to regularly report work status or document eligibility for an exemption." The peer-reviewed study in the New England Journal of Medicine found the policy was associated with big coverage losses and no significant change in employment.

Georgia tried a version too. Its "Pathways" program had enrolled just 6,500 adults as of January 2025 against a first-year projection of 25,000, and had cost the state and federal government over $40 million through June 2024 — with nearly 80% of that going to program administration and consulting fees rather than health care.

That's the record: people lose insurance, nobody gets a job, and the state pays consultants to run the paperwork machine.

What it costs, nationally

As KFF summarizes the Congressional Budget Office, the work requirement in the law that passed cuts federal Medicaid spending by $326 billion over ten years — the single largest piece of the law's $911 billion in Medicaid cuts. CBO has not scored how many people the enacted version will strip of coverage. Its analysis of the House-passed bill found that by 2034 "federal Medicaid coverage will decrease by an estimated 5.2 million adults," with the requirement "ultimately increasing the number of people without health insurance by 4.8 million."

$326 billion isn't found money. It is the cost of care that millions of people are projected to lose.

This is the same thing he's been doing for thirteen years

Bean's position on covering low-income people has been consistent since long before he got to Washington.

In 2013, as a Florida state senator, his alternative to expanding Medicaid under the Affordable Care Act would have rejected $51 billion in federal money offered to Florida over the following decade, spending $15 million in state money instead to stand up a small marketplace that charged enrollees $20 a month. It went nowhere. Florida has never expanded, and the 388,000-person coverage gap is the direct result.

In Congress, he's kept at it. He filed a bill in April 2026 to abolish the Medicare office that runs the dementia caregiver program and the diabetes prevention program, and he voted with his party to let the health insurance tax credits expire and spike premiums.

And he sits in exactly the right chair for it. Bean is on the Ways and Means Committee — and specifically on its Subcommittee on Work and Welfare, the panel whose entire job is tying benefits to work requirements.

The deadline is five months away

States have until January 1, 2027 to build the systems that will decide who keeps their coverage. Whatever those systems get wrong — a missed letter, a database that doesn't recognize a gig job, an exemption a caregiver didn't know to claim — comes out of someone's health insurance.

Aaron Bean didn't just vote for that. He drafted it, filed it, and filed it again.

He also won't take questions about it in person. When constituents held their own town halls in Fernandina Beach in 2025, Bean announced he "will not be attending any of the fake 'town hall' meetings sponsored by the Democrat Party and their cohorts," even though the organizer said the Democratic Party had no involvement and that everyone, whatever their politics, was invited to speak.

Source

H.R. 1279 — To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program, 119th Congress, introduced February 13, 2025. Photo: Official congressional portrait, 118th Congress.