Medicaid is getting a justified makeover on Jan. 1, when most states will begin implementing a work requirement as a condition of receiving benefits. The roughly trillion-dollar safety-net program had grown beyond its original purpose when legislatures chose to expand coverage to non-disabled working-age adults — many of whom don’t work and instead spend several hours per day watching television and playing video games. The goal of Republicans’ reform, a component of the One Big Beautiful Bill, is therefore laudable: Encourage adults to enter the labor force and potentially transition them to employer-provided health insurance.

Despite the hysterics, the new requirement is quite flexible. The number of people exempted — pregnant women, parents with a child under age 14, caretakers of those with disabilities and various others — is expansive. The law also allows states to choose how frequently Medicaid recipients must demonstrate compliance. According to a March survey, the majority of states plan to require the minimum of one qualifying month during each six-month period. (In other words, recipients only need to prove they’re working two months out of the year.) The requirement can be satisfied by working, training or volunteering 80 hours a month or by enrolling at least half-time in school. People could alternatively demonstrate countable household income of at least $580 a month — that is, $7.25, the federal minimum wage, multiplied by 80 hours.

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