By Bridge2Blue
Donald Trump’s HR1 (aka, the Big Ugly Bill) may have faded from public attention, but for tens of thousands of Virginians, its effects could soon become very real (including potential hospital closures in rural Virginia). And when it does, Virginia voters should remember that Virginia’s Republican members of Congress, including Jen Kiggans (R-VA02) and Rob Wittman (R-VA01) , supported Trump’s bill and the budget law that brought it into force.
Under HR1, beginning in January 2027, most adults covered by Medicaid Expansion will be required to document at least 80 hours per month of work, volunteer activity, or job searching. (Certain recipients, including people with disabilities and caregivers of young children, are exempt.) People enrolling or renewing cover age will also have to verify they met the requirement in a previous month. Already, some health care providers are advising their Medicaid patients to prepare to start documenting their job searches.
Will many Virginians be affected by these federal rules? Yes! More than 600,000 people are covered by Medicaid Expansion and, according to the Commonwealth Institute, the work requirement provision could take away coverage of 188,000—almost one-third of them—by 2034.
The problem isn’t necessarily that recipients don’t want to work or look for work. The big obstacle is that many will find it difficult to prove, twice a year, that they were looking for work or worked, especially if they do short-term or informal jobs
Public health care expert, Jonathan Oberlander, PhD, professor in the Department of Health Policy & Management at the University of North Carolina at Chapel Hill, emphasized that the administrative issues surrounding imposed work requirements are the biggest hurdle moving forward. He pointed out, “many Medicaid enrollees who work and are eligible for the program will nonetheless lose Medicaid coverage because of the administrative complexity and burden of the requirements.”
According to the Commonwealth Institute, adding red tape through work reporting does nothing to improve our current program and punishes people who may be fighting cancer or other serious conditions, gig workers, people between jobs, and caregivers.
Among those most affected will be adults with significant health challenges who don’t meet the formal criteria for a disability exemption. Yet these are the very people who most need Medicaid-funded health services.
Improved health has a direct and positive impact on the ability to work. As Prof. Minal Patel of the University of Michigan School of Public Health explained “our research [has] found that Medicaid coverage itself helps people return to work—employment nearly doubled among enrollees whose health improved—suggesting coverage can drive workforce gains”.
What’s more, some Virginia hospitals and health care practitioners will find that many patients will no longer have their bills covered by Medicaid. Those providers will either have to turn the patients away, or absorb the costs.
And public service agencies will have to undertake comprehensive education and outreach campaigns to ensure Medicaid enrollees understand the new reporting requirements and compliance procedures. At the same time, caseworkers will need to learn and manage the new eligibility requirements.
It is particularly galling that Rep. Kiggans, who is a nurse practitioner, supported measures that will result in thousands of Virginians being deprived of the health care they need. While Rep. Kiggans and Rep. Wittman signed a letter on 14 April 2026 urging House Republican leadership to preserve Medicaid, just over a month later, they voted against Virginians – including their own constituents – when on May 22, they voted in favor of the House budget reconciliation bill that included the largest Medicaid cuts in U.S. history.
Virginia Democratic Party Chair Lamont Bagby correctly pointed out that both Rep. Kiggans and Rep. Wittman initially promised “to protect this critical program, and then broke that promise to score points with Donald Trump and his billionaire backers. These cuts are not just numbers on a page—they’re real consequences for working families, children, seniors, and people with disabilities. Virginians won’t forget who stood with them, and who sold them out.” Exactly!
For more information about the new federal Medicaid rules in Virginia, go to https://www.dmas.virginia.gov/media/grxpncnd/work-community-engagement-requirement-faqs-02-10-2026-english.pdf.
