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a cce s s H ea l t h N ews . n e t M a rc h 2 0 2 6 Volume 11 | Issue No. 104 46 aH Medicaid Work Requirement Could Pose Challenges in Rural Communities L ast November, intentions to shake up safety net programs, like Medicaid, were communicated in plain English. "I know people that work three jobs and they live next to somebody who doesn't work at all," Mr. Donald Trump declared. "And the person who is not working at all and has no intention of working at all is making more money and doing be er than the person working his or her *** off.. In April, he issued an executive order that requires Medicaid beneficiaries to seek work in order to maintain insurance benefits. Most people would agree that moving individuals from poverty to work is in fact a win/win. However, in rural areas, finding work is not that simple. "In 2017, the Federal Government spent more than $700 billion on low-income assistance," according to language in the executive order. "Since its inception, the [welfare] system has grown into a large bureaucracy that might be susceptible to measuring success by how many people are enrolled in a program rather than by how many have moved from poverty into financial independence." Historically, Medicaid excluded low-income adults without dependent children. Medicaid roles increased with passage of the Affordable Care Act (ACA), which allowed states to opt for or against expanding Medicaid programs to low-in- come, childless adults. This resulted in 12 million additional enrollees who no longer had to depend on ERs as their entry into the health care system. Missouri opted out of Medicaid expansion. According to Robert Wood Johnson Foundation (RWJF) estimates, the state has lost and is losing $17.8 billion in Medicaid funding and $6.8 billion in hospital reimbursements between the years 2013 to 2022. RWJF estimates it would have cost Missouri $1.6 billion to participate in Medicaid expan- sion. The Kaiser Family Foundation's State of Health Facts reported that in 2016 Missouri ranked 49th in per capita expenditures on health care. In states where Medicaid roles increased due to ACA, it is important to note that 60 percent of adults receiving this government-funded health insurance benefit are employed. Published in May 20218