H.R. 567
Medicaid Fiscal Responsibility Act
Also known as: "Medicaid Work Requirements Bill"
Sponsored by Rep. Jason Smith (R) · 44 cosponsors
Legislative timeline
Introduced
In committee
Markup in House Budget Committee; passed out of committee on party-line vote
Last reviewed by our editors: Apr 22, 2026
What this bill does
H.R. 567 would impose federal work requirements on Medicaid enrollees aged 19-55 classified as 'able-bodied,' requiring documentation of employment, job training, education, or community service for 80 hours per month to maintain coverage. The bill also caps federal matching payments, freezes expansion enrollment, and creates an optional block-grant financing model.
CBO preliminary analysis estimates 2-4 million people would lose Medicaid coverage within five years. The Arkansas work requirement experiment documented 18,000 coverage losses with no measurable employment increase.
Who benefits
States seeking greater administrative flexibility to manage Medicaid rolls. Fiscal conservatives who prioritize deficit reduction through entitlement contraction. Under the block-grant option, states with stable enrollment would receive more predictable federal funding.
Who loses / who opposes
Low-income hourly workers in unstable employment, disproportionately Black and Latino. Adults with disabilities who are misclassified as 'able-bodied.' Working caregivers. Rural residents with limited internet access to report work hours. CBO estimates 2-4 million would lose coverage, with disproportionate impact on Black and Latino adults in non-expansion states.
Impact on Black communities
Black adults have lower rates of employer-sponsored insurance and higher Medicaid enrollment rates relative to white adults. In the 10 states that have not expanded Medicaid, Black adults are already overrepresented in the coverage gap. The Arkansas work requirement experiment (2018) showed Black enrollees experienced the highest rates of paperwork-related coverage loss. Block grant financing eliminates Medicaid's counter-cyclical function, reducing coverage precisely when unemployment rises — a pattern that hits Black workers first and hardest.
What you can do
Contact Senate Finance Committee members — this bill needs their buy-in and the Senate has bipartisan history of rejecting work requirements. Phone 202-224-3121.
Share your Medicaid story via Families USA (familiesusa.org). Coalition resources: NAACP Legal Defense Fund (naacpldf.org), National Health Law Program (healthlaw.org).