Medicaid may be about to change in a big way: Republicans in Congress are getting closer to passing a bill that, along with cutting taxes and imposing new immigration restrictions, would require people to work — or else risk losing government health benefits. It’s a change the party has long desired.

Right now, if you qualify for Medicaid, the government health insurance program for low-income people, based on your earnings, assets, and life circumstances, you can receive health coverage through the program — no other questions asked.

Nearly 80 million people are currently insured by Medicaid, making it the single largest insurance program in the US. Under the current law, there is no obligation to work or fulfill any other community service requirement in order to receive your Medicaid benefits.

But now, the GOP’s One Big Beautiful Bill Act, which passed the House by one vote early Thursday morning, would establish nationwide work requirements for the program for the first time, starting at the end of 2026. If the bill becomes law, people who became eligible for the program under the Affordable Care Act — generally, adults without children living in or near poverty — would be required to report at least 80 hours of work every month or another community activity such as volunteering, or they could lose their benefits.

Seniors, people with disabilities, caregivers for dependent people, and pregnant people are supposed to be exempted under the bill as currently written, but there’s some gray area here. Some of the decisions about how to implement the requirements will be left to the states: They could, for example, require Medicaid enrollees to report their activities every month or every six months. (Prior research has found that additional reporting requirements tend to lead to more people losing benefits.)

The Congressional Budget Office estimates that 10.3 million people would lose their Medicaid coverage by 2034 under the GOP bill, about half of them due to the work requirement provision. Other losses would result from a number of smaller provisions, according to the estimate. These include things like more frequent and stringent eligibility checks that will also require people to jump through........

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