Disrupting Disinformation: The Medicaid Discussion

A project of Indivisible 1431

As tax-paying Americans, we all want the government to spend our investment wisely. There has been considerable effort to sow fear that the government is not achieving that goal. There is no doubt that it is desirable to have continuous assessment and adjustment of the allocation of resources to that endeavor to avoid waste and, to a realistic extent, prevent or at least detect fraud. However, solutions to problems must begin with an accurate premise.

Russell Vought has said that “$1 out of every $5 -$6 in Medicaid (benefits) is improper.” If that were true, that would mean Medicaid’s improper payment rate is 16% to 20%. The Centers for Medicaid and Medicare Services (CMS) reported in 2024 that Medicaid’s improper payment rate over the prior three years was 5.1%, representing a decline from 8% during the previous reporting period. It is essential to understand how fraud, waste, and abuse are officially defined by the federal government agency.

· Fraud: "When someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program."

· Waste: "Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program. Examples of waste are conducting excessive office visits, prescribing more medications than necessary, and ordering excessive laboratory tests."

· Abuse: "When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program," which can include overbilling or misusing billing codes.

The tricky part here is understanding that improper payment refers to claims and authorizations for services, not the enrollees' eligibility. Improper payments are more of a reflection of waste and abuse resulting from mishandled authorizations and providers' or suppliers' misuse of resources. The good news is that states and federal agencies already have oversight and inspectors general in place to combat this. I am personally involved in authorization oversight and aware of all the departments that provide claims oversight, as well as eligibility oversight within our state Medicaid agency. These departments are hardworking, nonpartisan, subject matter, and public policy experts. The oversight is already in place.

Let’s examine the eligibility issue that is a large part of the Big Beautiful Bill Medicaid changes. There are two concerns often cited regarding eligibility. Those are work requirements, and the extent to which residents with undocumented status are provided Medicaid services.

The Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 bars undocumented immigrants and immigrants without permanent status (such as DACA recipients, TPS holders, or nonimmigrant visa holders) from accessing federal benefits, including Medicaid and CHIP. The Emergency Medical Treatment and Labor Act (EMTALA) ensures that all patients, regardless of citizenship or immigration status, have access to emergency medical treatment. The purpose of EMTALA is to ensure that all Medicare-participating hospitals do not turn away individuals who need lifesaving care. Undocumented immigrants’ use of EMTALA-related services is often covered via emergency Medicaid. Those expenditures are for the benefit of the hospital provider who had to render services. It does not represent the eligibility of undocumented immigrants to access broad Medicaid services. When you visit the CMS eligibility website, it clearly states that undocumented immigrants are ineligible for Medicaid and insurance through the Affordable Care Act exchange.

It is essential to understand that Medicaid is a program funded by both state and federal funds. According to recent CMS Medicaid data on state-level spending, in 2016, states spent a range of $0 to over $150 million (in California, Illinois, and Texas) on emergency medical services for undocumented individuals. California, as an example of the upper end of this range, spent $174 million on these emergency services, which represented .6% of California Medicaid expenditure that year. This is seen as necessary for rural hospitals, especially, to receive reimbursement that can mean the difference between survival and closure.

The other concern often cited around eligibility has to do with employment. In a CNN Newsnight with Abby Phillip on July 1, 2025, Scott Jennings amplified disinformation about able-bodied Medicaid recipients not working. He stated that almost 5 million able-bodied Medicaid recipients “simply choose not to work” and “spend 6 hours a day socializing and watching television”. That certainly sounds concerning that 5 million are defrauding, or at least, abusing the Medicaid benefit.

The basis of his talking point referenced the Congressional Budget Office (CBO) analysis. The CBO analysis projected that 4.8 million would lose coverage through 2034 due to the inability to fulfill the community work requirements under the new legislation. The talking point assumed a lack of interest, but it is more complex than that.

A survey by the Urban Institute found that 2% of nonworking enrollees without dependents, or about 300,000 enrollees, cited a lack of interest in working. Other research diving into that lack of interest found it was due to a variety of reasons.

KFF, an independent source for health policy research, cited a study on June 25, 2025, that one in five (21%) of Medicaid adults were not working or did not work enough hours to meet the requirement for reasons including the inability to find work or sustain work hours, having been laid off, retirement, and school attendance. These reasons put them at particular risk of not meeting the new work requirements.

My experience, spanning over 35 years as a Speech-Language Pathologist providing services to Medicaid and Medicare patients, is consistent with this analysis. Chronic disability doesn’t go away because an enrollee turns of age for employment. It may require long-term services and support to remain employed. Those services are necessary for there to be adequate care for caregivers to work gainfully and contribute to the economy. The disinformation that 5 million people are lazy is merely fear-mongering and doesn’t accurately reference the CBO analysis.

New work requirements under the Big Beautiful Bill will require able-bodied Medicaid recipients aged 19-64 to work, volunteer, or attend school for 80 hours per month to qualify for Medicaid. There are some exemptions in place for those who are disabled, pregnant, or have a child under the age of 14. The legislation officially defines “able-bodied” people as those not medically certified as physically or mentally unfit for employment. States are given until January 1, 2027, to implement the new work requirements, although the exact timing may vary. Some states are expected to implement the criteria sooner. Others are likely to request a good-faith waiver, which would extend the deadline to January 1, 2029, provided they are working towards implementation.

On the surface, one might think this is not a bad solution for ensuring beneficiaries contribute, and some definitions address part of that 21% we discussed earlier. However, several studies based on previous state expansions of work requirements have been conducted, and recent behavioral economic studies suggest that work requirements create an administrative paperwork barrier to accessing services for eligible beneficiaries.

The findings of these studies are complex, including poverty, education, and psychological obstacles to navigating a more complex eligibility process. These factors were included in the CBO’s analysis, which indicated that the new legislation would result in 10.3 million people losing Medicaid coverage by 2034 and 7.6 million people becoming uninsured. Therefore, it appears that the new legislation, which aims to address the issue of 300,000 enrollees with complex reasons for not meeting the work requirement, will impact the healthcare access of 10.3 million Americans.

Given the complexities of the lives and circumstances of Medicaid enrollees, we can all agree that a sledgehammer to remove a tiny screw isn’t just too much of a tool for the job_ it is the wrong tool for the job. What we need is a careful analysis of resource distribution to achieve the best outcomes. The loss of benefits also means a heavier burden on hospital systems that may fail. That means job losses—unintended consequences to our economy. Over the last decade, a majority of Americans have come to agree that healthcare is a right, not a privilege, one that should be accessible to all, regardless of their financial resources. Honoring that requires a solution crafted from careful analysis of our objectives based on true premises, not based on reaction to manufactured fear.

Truthify’s mission is to provide a means for building informed conversations that allow you to ask if disinformation around a topic exists. Disinformation is defined as erroneous information deliberately spread to manipulate or deceive for profit or political gain. This bill seeks to address a nonexistent problem, which will reduce costs, as budget adjustments will be necessary to accommodate the tax cuts for billionaires to write off luxury items, resulting in a revenue loss. Perhaps this article will help you disrupt that disinformation thread.

References

• FactCheck.org, “The CBO Breakdown on Medicaid Losses, Increase in Uninsured”, D’Angelo Gore, July 11, 2025.

• PolitiFact, “Federal funds are not used to enroll undocumented immigrants in Medicaid in New York”, Jill Terreri Ramos, June 22, 2025.

• KFF, “State Health Coverage for Immigrants and Implications for Health Coverage and Care”, Akash Pillai, Drishti Pillai, and Samantha Artiga, May 1, 2024.

• PolitiFact, “What’s an ‘improper’ Medicaid payment, and is it as high as a Trump official said? “, Louis Jacobson, June 4, 2025.

• KFF, State Health Facts, Medicaid Expansion Enrollment Tracker, June 2024.

• PolitiFact, “Are 5 million able-bodied Medicaid recipients watching TV all day? That’s unsupported”, Loreben Tuquero, July 9, 2025.

• KFF, “Different Data Source, But Same Results: Most Adults Subject to Medicaid Work Requirements Are Working or Face Barriers to Work”, Jennifer Tolbert, Sammy Cervantes, and Gary Claxton, June 25, 2025.

• KFF, “Medicaid Enrollment and Unwinding Tracker”, July 2, 2025

• Benefits By State, “Do Illegal Immigrants Get Medicaid? All You Need to Know”, May 17, 2025.

• National Immigration Forum, “Fact Sheet: Undocumented Immigrants and Federal Health Care Benefits”, September 21, 2022

• SILive.com, “When do new Medicaid work requirements in ‘Big Beautiful Bill’ take effect?” Eric Bascome, July 07, 2025.

• KFF, “A Closer Look at the Medicaid Work Requirement Provisions in the 'Big Beautiful Bill”,

• Elizabeth Hinton, Amaya Diana, and Robin Rudowitz, June 20, 2025.