Sometimes, smart execution can soften the blow of bad policy. Virginia’s policymakers and tech community have a unique opportunity to do just that. They can protect Virginians and set a model for the nation when it comes to health coverage, and Gov. Spanberger’s executive order creating an “Interagency Health Financing Task Force” gives Virginia that opportunity.
First, the problem: the Republicans’ 2025 Budget Reconciliation Bill (the so-called “One Big Beautiful Bill”) has a policy baked into it that we know has failed: work requirements for Medicaid. In other states, they have caused thousands of people to lose coverage and fall deeper into medical debt. Some have even lost their jobs because they couldn’t get the care they needed.
Here’s the problem with a policy saying, “adults on Medicaid should work.” Almost all of them already do. If you took a group of 30 Virginia adults on Medicaid today, 21 of them would already be working full-time or part-time. Four aren’t “working” right now because they’re caring for a child or an elderly relative (more than a full-time job itself). Three others aren’t able to work because they’re sick or disabled. One isn’t working yet because she’s a student.
So, out of that entire group of 30 people, there might be one single person who isn’t working, but theoretically could be.
Work requirements force every one of those 29 other people to fill out more paperwork to prove they’re not that one person. If they don’t, or just forget because they’re busy, they could lose their coverage entirely. And this happens predictably. So many people lose coverage from this paperwork that Republicans were able to count on billions in “savings” to pay for some of their new tax cuts for the wealthy, because they knew people would lose health coverage from this new red tape.
Arkansas is perhaps the most notorious example of work requirements gone wrong. In 2018, the state conducted one of the nation’s largest experiments on Medicaid work requirements, with the blessing of the first Trump Administration. In less than a year, 18,000 Arkansans had lost Medicaid — and not because that many people weren’t working. Many already had jobs, but found it hard to prove they were working. The people who weren’t working found it hard to prove that they could meet the qualified exemptions. It was a textbook case of a “termination trap,” as the only way people could prove their eligibility was through a glitchy website that shut down between 9 p.m. and 7 a.m. and didn’t work well on smartphones.
Unfortunately, Arkansans’ nightmare has come to Virginia’s doorstep. Thanks to Republicans in Congress, every state will have to implement work requirements starting in 2027. Not only are the requirements themselves new for many states, but states will also have to decide how they track exemptions like “community service” or how to quickly prove someone is an enrolled student. With current practices and systems, simply managing the normal churn of people on and off Medicaid rolls can be challenging for agency staff and technology; these new requirements will swamp the system and put coverage for everyone at risk.
But Virginia has a tool that can help. Specifically, Gov. Spanberger’s second executive order. It establishes a cross-agency “Interagency Health Financing Task Force” to find ways to maximize federal funding, reduce duplicative spending and strengthen Virginia’s health care infrastructure. Crucially, it also directs the task force to work with the chief transformation officer and the secretary of administration to “review systems used across agencies to avoid duplication in technology platforms, licensing, and procurement.”
This is exactly the opening Virginia needs to ensure that, when Medicaid work requirements are forced on our state, no one loses coverage unnecessarily.
The commonwealth should not do it alone. The task force should also reach out to Virginia’s tech community — proposing contests, hackathons and other ways to find new tools and consumer-friendly ways to cut through bureaucratic red tape and make the process of verifying income and eligibility as easy as possible. The nonprofit “Code for America” is setting a strong example here. They offer services to states and policymakers like automated renewals and pre-filled forms for Medicaid redeterminations, automating income verification and using human-centered design for work requirement compliance. Similarly, tech leaders in Virginia could find new ways to instantly and safely share data between agencies, develop consumer-friendly and convenient apps, and figure out how best to raise awareness of the new Medicaid requirements.
Just a few years ago, the hardworking people in Virginia Medicaid completely redesigned the program to bring affordable health coverage to hundreds of thousands of Virginians through Medicaid expansion. Unfortunately, the commonwealth is going to require that reinvention and aggressive execution again — this time to protect thousands of Virginians from losing health coverage. But the governor and her new administration have given them new tools to do it, and if Virginia’s tech community answers the call, they won’t have to do it alone.
Brian Chiglinsky, a native of Salem, is a health care communications consultant and was the former director of speechwriting at the U.S. Department of Health and Human Services in the Obama administration. He has experience in health care startups, as well as local, state and federal government, and can be reached at brian.chiglinsky@gmail.com. He would like to thank Thomas Gates for his research and expertise.
