H.R.1 is not the first attempt at Medicaid work requirements. In 2018, Arkansas implemented a community-engagement requirement under a federal waiver. The program ran for only a few months before a court halted it, but in that short window it produced the clearest evidence we have of what happens when these rules meet real people. The numbers should shape how every plan and state approaches 2027.
The headline number
Over the course of the Arkansas program, roughly 18,000 people lost their Medicaid coverage. To put that in perspective, that was about one in four of the enrollees who were subject to the requirement during the period it was active. Coverage losses on that scale, concentrated in a single state over a handful of months, are why the Arkansas experience is treated as the central precedent for H.R.1.
Why people actually lost coverage
The crucial finding from Arkansas was that the disenrollments were overwhelmingly procedural, not substantive. Studies after the fact found no meaningful increase in employment attributable to the requirement. Many of the people who lost coverage were already working or would have qualified for an exemption. They lost coverage because they did not know about the requirement, did not understand the reporting process, could not navigate an online-only reporting portal, or never received clear notice.
Awareness was strikingly low. Surveys showed that a large share of the affected population was either unaware of the requirement or confused about whether it applied to them and what they needed to do. The reporting system itself was a barrier: it was difficult to use, had limited hours, and assumed a level of internet access and digital literacy that many enrollees did not have.
The lessons for 2027
The Arkansas precedent is not an argument about whether work requirements are good policy. It is operational evidence about failure modes. If the dominant cause of coverage loss is procedural, then the dominant lever for preventing it is communication: telling members clearly that the rule exists, whether it applies to them, what counts, how to report, and how to claim an exemption.
H.R.1 operates at a far larger scale than one state's waiver. Applied nationally, the same procedural failure rate would translate into a much larger absolute number of people losing coverage they are entitled to. The window to prevent that runs through the June 30 to August 31, 2026 notice period and up to the January 1, 2027 enforcement date. Arkansas is the warning; the response is whether outreach is built before, not after, the disenrollments begin.