Washington state is constructing an automated verification system to check whether Medicaid recipients meet new federal work requirements, but the state's public response has avoided expanding employment services, according to a report published by the Washington Policy Center. The system is designed to use existing records to confirm whether recipients satisfy the mandate or qualify for an exemption, minimizing paperwork for many enrollees. State officials estimate the automated hub could verify roughly 400,000 of the approximately 600,000 Washington residents potentially subject to the requirement, which takes effect Jan. 1, 2027.
Apple Health — Washington's Medicaid program — covers nearly 2 million state residents, with about 600,000 adults in the Affordable Care Act's Medicaid expansion group potentially affected by the work mandate. Under H.R. 1, most Medicaid recipients ages 19 to 64 must complete at least 80 hours monthly of employment, community service, work program participation or another qualifying activity — or attend school at least half time. Not all 600,000 expansion adults will need to find jobs, since some already meet the requirement and others qualify for exclusions or exemptions available to certain parents, caregivers, American Indians, Alaska Natives, veterans with total disability ratings and medically frail individuals. The state plans to allow recipients to self-report their income, employment or exemption status throughout 2027 when electronic records can't verify compliance. The federal government generally pays 90 percent of benefit costs for adults covered through Medicaid expansion, while the state pays 10 percent — equivalent to nine federal dollars for each state dollar.
Gov. Bob Ferguson described the federal changes as "morally bankrupt" at a Sept. 3 press conference and said it "really ticks me off" that the state must respond to them, according to the report. Ferguson signed an executive order creating an H.R. 1 response committee that directs state agencies to coordinate outreach, monitor coverage losses and help recipients respond to new eligibility procedures — reinforcing the administration's stated objective of preserving coverage for as many current recipients as possible. The Health Care Authority's public materials and the governor's press communications don't identify any expansion of Medicaid-specific employment, job-placement or training services, even though Washington has high unemployment and more than 600,000 adults in Medicaid expansion. A 2024 state performance audit found that the state made an average of about $8.6 million yearly in unnecessary managed-care premium payments for people concurrently enrolled in Medicaid in Washington and at least one of seven other states examined.
The report explains that lower enrollment will reduce federal Medicaid payments flowing into Washington, which may account for the governor's resistance more than moral objection. While decreased enrollment will also cut the state's corresponding share of benefit expenses, opponents of work requirements worry that savings will be overwhelmed by possible consequences such as increased uncompensated care at hospitals when people lose insurance. The report argues that automatic verification can make it easier to remain eligible for Apple Health, but it doesn't help someone who isn't working obtain employment, enroll in training or begin another qualifying activity. The decision to allow self-attestation of employment during 2027 raises questions about program integrity, subsequent auditing and how the state will address false or inaccurate statements, particularly given past audit findings.
The report concludes that the possible benefits of work extend far beyond taxpayer savings, including livelihood, confidence, purpose, achievement, positive relationships, community inclusion and structured routines that can increase household income and create opportunities to move beyond dependence on public assistance. Washington state is building an extensive system to determine who meets the new requirement and who doesn't, but the larger test is whether the state will be as eager to help people trying to find work. The good that can come from H.R. 1's work requirements will be measured in jobs, earnings, skills and greater independence — not merely in federal tax savings.