Dr Oz’s Prescription for Making Medicaid “Viable at Every Level”
On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that means), but I imagine he’ll be confirmed along party lines.
Many Americans first encountered Dr Oz through his appearances on Oprah, and his potential transition to overseeing insurance programs that provide health coverage for half the country represents a significant shift in responsibility. However, the more pressing issue at hand isn't about his television background.
It’s about work requirements.
A topic that’s been echoed throughout the life of Medicaid, work requirements have yet again taken center stage in the debate around where $880 billion in budget cuts will come from. It will be impossible to avoid Medicaid to achieve those budget goals, but President Trump’s Cabinet picks are already telling us how, in part, they plan to accomplish this: adding work requirements could translate to $120 billion in savings for the program.2
Put another way, millions of eligible Medicaid beneficiaries could inadvertently lose health coverage due to burdensome reporting requirements.
Medicaid work requirements are policies that make health coverage contingent on beneficiaries working, volunteering, or participating in educational activities for a minimum number of hours each month. Recent proposals would require working-age Medicaid beneficiaries (typically ages 19-64) to prove they are working or engaging in approved activities for at least 80 hours per month (20 hours per week).3
While these policies may sound reasonable on the surface—after all, nearly two-thirds of adult Medicaid enrollees already work—let’s review the details:3
- Monthly Reporting Burden: Beneficiaries must document and report their work hours every month, often through online portals that may be inaccessible to those without reliable internet access or digital literacy.
- Complex Exemption Process: Those who qualify for exemptions (people with disabilities, caregivers, and students) must regularly apply for and renew these exemptions, requiring paperwork from physicians or other documentation.
- Verification Challenges: Even those who work may struggle to verify their hours, especially if they have multiple jobs, irregular schedules, or employers unwilling to provide documentation.
- Administrative Hurdles: States must process millions of reports and exemption requests, creating bottlenecks that can result in eligible people losing coverage due to processing delays.
- Lack of Support Services: Many proposals don't include additional funding for job training, transportation, or childcare—resources that would actually help people secure employment.
For someone juggling multiple part-time jobs, caring for family members, dealing with chronic health conditions, or living in areas with limited job opportunities, these requirements can create insurmountable barriers to maintaining health coverage.
The evidence from states that have implemented work requirements is clear and concerning. In Arkansas, about 18 000 people—1 in 4 enrollees subject to the requirements—lost coverage in just 7 months before a federal court halted the program. Many of these individuals should have remained eligible but couldn't navigate the complex reporting systems.3
Even in New Hampshire, which attempted to learn from Arkansas's mistakes with more flexible reporting and robust outreach, two-thirds of enrollees were likely to be disenrolled after just 2 months due to widespread confusion.3
Most recently, Georgia's implementation of work requirements as part of a limited expansion has resulted in only 6500 people gaining coverage after 18 months—far below the 240 000 potentially eligible. The program has cost approximately $13 360 per enrollee, with two-thirds of spending going to administrative expenses rather than health care.3
Dr Oz's support for work requirements during his confirmation hearing suggests that this mechanism could be his preferred method for achieving what he calls making Medicaid "viable at every level." By framing work requirements as a pathway to self-sufficiency rather than as a budget-cutting measure, he can present the policy as beneficial to members while simultaneously reducing enrollment numbers.
This approach allows the administration to claim they're not cutting benefits for those who "truly need them" while still achieving substantial savings through administrative attrition—as people fall off the rolls due to paperwork barriers rather than explicit eligibility changes.
The reality is that work requirements function primarily as a bureaucratic obstacle course that disproportionately impacts those with the least resources to navigate complex systems—precisely the vulnerable populations Medicaid was designed to protect.
As Dr Oz prepares to take the helm at CMS, the battle over Medicaid's future intensifies. The administration's approach to work requirements will be a critical indicator of its broader health care agenda.
For those concerned about preserving access to health care for vulnerable populations, the focus must remain on the evidence: work requirements create administrative barriers that lead to coverage losses among both working people and those the policies purport to exempt, without increasing employment.
The coming months will reveal whether policymakers will prioritize budget cuts over health care access, or whether they'll seek more effective approaches to strengthen Medicaid while ensuring it serves those who need it most.
References
1. Simmons-Duffin S. 5 things to know as Dr Oz gets one step closer to leading Medicare and Medicaid. NPR. March 25, 2025. Accessed March 26, 2025. https://www.npr.org/sections/shots-health-news/2025/03/25/g-s1-55766/dr-mehmet-oz-medicare-medicaid-cms-trump
2. Lukens G, Zhang E. Medicaid work requirements could put 36 million people at risk of losing health coverage. Center on Budget and Policy Priorities. Updated February 5, 2025. Accessed March 26, 2025. https://www.cbpp.org/research/health/medicaid-work-requirements-could-put-36-million-people-at-risk-of-losing-health
3. Coleman A, Federman S. Work requirements for Medicaid enrollees. Updated January 14, 2025. Accessed March 26, 2025. https://www.commonwealthfund.org/publications/explainer/2025/jan/work-requirements-for-medicaid-enrollees
