The new Medicaid work requirements, set to take effect next year in most states, could jeopardize health coverage for hundreds of thousands of farmworkers who rely on the program.
These rules require adults enrolled in Medicaid to demonstrate they work, attend school, or volunteer at least 80 hours a month. For farmworkers, whose employment is often seasonal and irregular, proving compliance may be difficult. Many work over 80 hours during harvest seasons but struggle to meet the threshold in off-season months when they take on informal jobs or face unemployment.
Advocates warn the rule will disproportionately affect farmworkers, who frequently switch jobs, work cash-only gigs, or lack formal paychecks. While eligibility can be verified using average income over six months, the process adds layers of bureaucracy. Alexis Guild, vice president of strategy and programs at Farmworker Justice, said the requirement creates more paperwork and more proof for workers already handling unstable schedules. Farmworkers and others with seasonal jobs face periods when no work is available, she added.
More than 2.9 million farmworkers support the U.S. food system, with nearly 60% being U.S. citizens or legal residents. Despite this, the uninsured rate among farmworkers is three times higher than the general population. Medicaid covers most insured farmworkers, though participation rates vary by state. A 2021 study found that agricultural workers with legal documentation became 24% more likely to have health insurance after Medicaid expansions tied to the Affordable Care Act, which may impact health insurance premiums.
For farmworkers with green cards or citizenship, the Medicaid application process raises fears of sharing personal information with immigration authorities. Luis, a 45-year-old green-card holder in North Carolina, said he worries about proving 80-hour work months. His experience reflects a broader concern: that seeking healthcare could expose workers to legal risks.
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Even when eligible, farmworkers face systemic hurdles. Transportation, sick leave, and limited access to clinics often prevent them from receiving care.
Chronic conditions, including respiratory illnesses, are common among farmworkers, yet delayed care can worsen outcomes and increase long-term costs. They face significant challenges in maintaining their health due to the nature of their work.
The new rules also require beneficiaries to verify eligibility twice yearly, doubling the previous frequency. For mobile workers who travel across states, this adds complexity.
Agricultural work is among the nation’s most dangerous jobs, the new rules risk deepening health disparities for a population already facing significant challenges.
