Doctor typing information on Laptop in Hospital office focus on Stethoscope
In certain U.S. states, proposed and limited Medicaid work requirements are putting gig workers and other independent contractors in a precarious position. They could risk losing access to health coverage – not because they aren’t working, but because they struggle to prove they are. Some states have sought federal approval to implement rules that require Medicaid recipients to verify they work at least 80 hours per month to remain eligible for benefits. While the stated goal is to promote employment, these policies often ignore the nature of today’s decentralized and irregular workforce. For gig workers and part-time employees, providing proof of consistent work hours can be challenging.
Gig workers – like app-hail drivers – often do not follow traditional schedules. While one month may include 120 hours of work, another might come in just shy of 80. Income can fluctuate dramatically, and hour-by-hour logs are often unavailable.
Employers typically use platforms to track workers’ time and issue payments. These rarely include breakdowns of hours worked. Most freelance platforms issue lump-sum payments with no accompanying paystub or breakdown of hours worked. Workers might receive a weekly or monthly statement of earnings, but these documents often fail to meet the verification standards Medicaid agencies require. The burden of tracking hours shifts entirely to the worker.
Independent contractors are typically issued a 1099-NEC form at the end of the year, summarizing their annual income, rather than the number of hours or monthly work. That leaves a significant gap between what Medicaid asks for and what the worker can easily access. Features such as hour tracking, customizable reports or responsive payroll support are often lacking. Even if the data exists, companies may be hesitant to provide documentation that blurs the line between contractor and employee, especially if it could suggest worker misclassification, thereby exposing them to legal risk.
Gig workers also often combine income from multiple sources, including driving for Uber and DoorDash, taking on Upwork projects and completing odd jobs through TaskRabbit. They may work more than 80 hours a month. However, the labor is spread across platforms with no shared reporting standard, making piecing together a comprehensive monthly record a nightmare. Add to that the practical barriers of navigating online portals, limited internet access or language barriers, and even highly motivated workers can fall through the cracks. Government systems aren’t known for being user-friendly, especially for those who are digitally or financially vulnerable.
Most Medicaid work requirement proposals include exemptions for people who are pregnant, medically frail, disabled or acting as caregivers for dependents. However, applying for these exemptions requires additional documentation. This creates yet another layer of administrative complexity that can trip up eligible individuals.
Most people who lose Medicaid coverage due to work requirements do so not because they failed to work, but because they failed to report properly. As Medicaid programs begin enforcing work and income verification rules more strictly, these structural flaws must be addressed. Without reform, workers risk being penalized, who are already meeting the requirements but struggle to prove it.
Governor Hochul joined elected officials and health leaders in August to denounce the sweeping federal legislation in the Trump administration’s One Big Beautiful Bill, which will fundamentally change healthcare in the U.S. According to the Governor’s Office, the new law will eliminate insurance for millions, spike out-of-pocket costs, and cost local hospitals billions of dollars.
State officials and health experts warned the consequences go beyond those losing coverage. Hospitals may be forced to eliminate critical services such as maternity care, psychiatric treatment, and even face closures due to the combined pressure of lost revenue and increased demand from newly uninsured patients.
- 5 million New Yorkers could face loss of insurance coverage.
- $13 billion in health care funding would be put at risk.
- Local hospitals could see over $30 million in losses from uncompensated care in NY-24 alone.
- Premiums could rise 30% or more for insured couples on the Marketplace.
New York State is expected to pursue legal and legislative action to mitigate the effects of the cuts. Governor Hochul vowed to use “the full weight of New York State” to protect residents.
Sources: HR Executive, Fingerlakes1.com
