Fears, Questions Weighing on Older Adults as Medicaid Work Requirements Loom

Chronic conditions make Medicaid vital to their health but work requirements will be harder to meet

Miriam Cross,

AARP

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Published January 29, 2026

Donnie Fredriksen hesitated to enroll in Medicaid, even as his lung condition worsened and he had to leave his job at a lumber mill.

Tony Luong

Donnie Fredriksen misses going to work.

The 59-year-old rural New Hampshire resident left his job at a lumber mill two years ago because inhaling microscopic particles was causing his lung condition to worsen.

After that, it was hard to get medical treatment because he didn’t have health insurance. Fredriksen’s pulmonologist refused to continue seeing him while he was uninsured, so a community health worker helped him apply for Medicaid.

Fredriksen initially hesitated to enroll.

“I never asked for help in my life,” he says. “But sometimes swallowing your pride is a life lesson.”

The joint federal-state Medicaid program, which helps cover medical costs for people with limited incomes, pays for Fredriksen’s doctor visits and the expensive tests that monitor his chronic obstructive pulmonary disease (COPD), an incurable condition that makes it hard to breathe. “Medicaid is a blessing,” Fredriksen says. He now lives on a friend’s property, in a structure he affectionately calls a shack, running through a list of tasks to fix up the place on the days his health allows. But he misses the socialization of his construction jobs, which he held since he was a teenager.

Starting next January, adults between the ages of 19 to 64 who rely on Medicaid for their health insurance will face additional hurdles if they want to keep their coverage. Most enrollees will be expected to work, volunteer or be enrolled in school for at least 80 hours per month to continue receiving their benefits. People 50 and older are in the most precarious position: They have higher rates of chronic conditions than younger generations, which makes Medicaid vital for their well-being. But older people often face more challenges finding or keeping a job, whether that’s because of age discrimination or physical limitations.

The federal government will exempt some people from complying with work requirements, including those deemed medically frail, with substance use disorders, disabled or on Medicare. That’s cold comfort to the older adults who wonder if their ailment will qualify and what documentation or process it will take to prove it. Here is how five older adults are navigating these concerns as work requirements take shape.

Fredriksen helps a friend fix up his property in rural New Hampshire on the days his health allows.

Tony Luong

Paying into the system

Donnie Fredriksen, 59

Washington, New Hampshire

Fredriksen wakes up every morning wondering how hard it will be to breathe.

The toll is more mental than physical. “Everyone goes off to work and I have to hang around and see what the day brings health-wise,” he says. He fell in love with roofing as a teenager, then moved on to other construction and remodeling gigs. His affable personality helped him get along with the alpha males in the trade. “I’m a people person,” he says.

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Still, he appreciates the arrangement he has with his friend, who understands that some days are better than others as Fredriksen helps improve his property. Fredriksen’s “shack” does not have running water, electricity or internet, but a wood-burning stove, a generator and batteries fill in the gaps.

“I’m fortunate,” Fredriksen says. “I’m indoors, I have heat, I have food. It can always be worse.”

He also feels fortunate to be on Medicaid, which covers the testing and treatment he needs to stay on top of his COPD. But so far, the rules outlining work requirements for people to stay on Medicaid seem vague. Even though Fredriksen has doctors who confirm he can’t work, he may face another challenge as the new rules materialize in 2027: navigating whatever system his state builds for people to document their exemptions. If New Hampshire requires documentation through an online portal, that would be a challenge for people like Fredriksen.

“I’m a total computer caveman,” he says.

Fredriksen believes you have to give something to get something. “Nothing is for free in life,” he says. But he likens Medicaid to Social Security — systems he has been paying into for decades.

“To take something away and change a lot of people’s lives,” he says, “that’s huge.”

a person standing outside of their house

Kathleen Niestadt hopes her full-time studies will let her stay on Medicaid.

Stacy Kranitz

Pursuing a degree to get ahead

Kathleen Niestadt, 55

Louisville, Kentucky

Kathleen Niestadt is at her healthiest when she’s on Medicaid.

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She enrolled in May 2025 after being laid off from her job at a children’s advocacy nonprofit due to budget cuts. Health coverage is crucial for Niestadt because she has several medical conditions, including multiple sclerosis, which requires infusions twice a year that each cost more than $200,000.

This is her second experience on Medicaid. While on the program in 2017, she noticed she was taking better care of herself.

“I didn’t have to skip my medicine to stretch it all out,” Niestadt says. “I could make all my doctors appointments.”

Niestadt started pursuing a bachelor’s degree in social work part-time in 2021. She is now a full-time student. She is on track to graduate in the spring of 2027, but she needs reliable health coverage to do so.

“Having to not have to worry about paying premiums and copays and deductibles is allowing me to pursue school at the full-time level,” she says. Her goal is to eventually become a licensed clinical social worker specializing in sexual abuse and human trafficking trauma.

Niestadt hopes her status as a student will exempt her from work requirements and allow her to stay on Medicaid but is waiting for more information. She wonders if she will need to find a job for the summer months when not in school. However, she is limited to positions with a hybrid schedule that are close to home because of the daily fatigue caused by her MS. She worries her age and health conditions will put her at a further disadvantage.

“I know the government doesn’t want to give handouts,” Niestadt says. “But where are these people getting rich off the government? Where are all these workarounds?”

Melissa Withem-Voss wonders if she could hold a part-time job without it negatively impacting her health.

Lucy Hewett

The mental strain

Melissa Withem-Voss, 52

Waukegan, Illinois

Melissa Withem-Voss spent time as a chef and helped open a casino. Medicaid has been there for her when she has been forced to leave these jobs, including because of an injury sustained by slipping in a walk-in freezer and a heart attack she suffered in 2023.

An inheritance from her father’s estate has also helped pay the bills for her and her two adult children who live at home while she has been out of work. Medicaid has also kept her going. Withem-Voss has psoriasis, psoriatic arthritis, type 2 diabetes and a hearing impairment. In 2024, she lost vision in her right eye after an eye stroke. “Think of yourself sitting in a movie theater and picture a head in front of you,” she says. “That’s how I see.”

She knows there will be exemptions from the upcoming work requirements. “But to be honest with you, with the way government has been, one day it’s one way and the other day it’s not,” Withem-Voss says. “It makes you very leery.” Getting a disability hearing has already been a chore: She applied in June 2023 and is still waiting for a resolution.

Withem-Voss volunteers with nonprofit Patients Rising and the National Psoriasis Foundation to advocate for patients’ rights when she is physically able. If need be, she wonders if she could combine volunteer hours with part-time paid work to make up the 80 hours required to stay enrolled in Medicaid. But her ability to hold a part-time job without negatively affecting her health is an open question.

She worries that the stress of figuring this all out could exacerbate her physical ailments.

“The biggest part for me is the mental strain,” she says.

Medicaid gave Nydia Hill the stability to get treatment for substance abuse and become a certified counselor.

Michael George

When a paycheck is a trigger

Nydia Hill, 62

Amsterdam, New York

Medicaid funded Nydia Hill’s substance abuse treatment after she spent time in jail more than 20 years ago for selling drugs. It kept her afloat as she progressed through night school to become a certified substance abuse counselor and gave her the stability to foster 15 children, including two she adopted. As a result, Hill knows firsthand why Medicaid is critical.

“Had I not been given that shot in 2003, I wouldn’t be where I am today,” she says.

Hill has been on and off Medicaid for the past two decades while between nonprofit jobs. She now relies on Medicaid to cover several health conditions, including an autoimmune disease and rheumatoid arthritis, and to pay for medication that would otherwise be unaffordable. Although she retired in August, she picked up a part-time gig in November driving at-risk teenagers to an after-school program. “I felt like I had more to give,” she says. The risk that her Medicaid could disappear without a part-time job also factored into her decision.

Hill underscores the importance of a slow return to work for those recovering from substance abuse and the role of Medicaid in that process. For some, a paycheck can be dangerous early on.

“Money is a trigger,” she says. Medicaid coverage allowed Hill to receive inpatient and outpatient treatment before finding a job three years into her recovery.

“Medicaid is a thank-you-God, an extra pillow I can lay on my bed,” says Jason Rodman.

Zach Dobson

Fitting into the right box

Jason Rodman, 58

Indianapolis, Indiana

Jason Rodman is familiar with the hoops to jump through and the precise boxes to check to receive government benefits.

It took him several tries to get approved for disability in 2012. Several years ago, the Damien Center, an HIV/AIDS services center in Indianapolis, helped him enroll in both Medicaid and Medicare. (Medicare is available to people under 65 who have been receiving Social Security disability benefits for 24 months.) “It’s a lot of googley-gook,” he says of the sign-up instructions. “Thank God I’m meticulous about keeping records.”

Once enrolled, he felt a weight come off his shoulders.

Rodman, who is HIV positive but with an undetectable viral load, refills seven to eight bottles of prescription medicine per month. Without these medications, he will become very ill. He is prone to falling and sometimes uses a cane. Seizure-like movements cause him to drop things from his hands.

“Medicaid has made me comfortable,” he says. “Medicaid is a thank-you-God, an extra pillow I can lay on my bed.”

When he was able to work, Rodman held retail and restaurant jobs. He bristles at the assumption that people like himself, who look able on the outside, are healthy enough on the inside — mentally or physically — to stay employed.

“You can say you want people to do 80 hours a month but there are people who really, really can’t work,” he says.

For now, Rodman compares the situation to being on vacation with a hurricane brewing on the horizon. He thinks he will be eligible for an exemption. But in his experience, “you have to fit into that box just right.”

When reviewing the exemption categories, “I thought, where am I?” Rodman says. “I’m not elderly and feeble, but I’m disabled. Is there a kind of disability they are looking at?”

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