Seasonal work. Inconsistent schedules. Frequent movements. Cash payments and informal jobs. For farmworkers who rely on Medicaid, these common employment patterns could put their health coverage at risk.
It's a major concern for the more than one million farmworkers who are U.S. citizens or legal permanent residents, as new work requirements take effect for the federal and state health care program that serves low-income and disabled Americans.
Starting next year, in most states, many adults enrolled in Medicaid will have to prove that they work, are enrolled in college or vocational courses, volunteer, or do unpaid work for at least 80 hours a month.
Advocates say this could pose a significant challenge for Medicaid-eligible farmworkers, who often work more than 80 hours a month during the harvest season, but less in other months. What's more, outside of the harvest season, many workers take informal jobs in construction, landscaping, or home repair for which they do not receive formal paychecks demonstrating their continued Medicaid eligibility. They can still establish eligibility by showing that their average monthly income for six months is equal to at least 80 hours of work at the federal minimum wage.
“Having a work requirement — having to create more paperwork and more evidence — is certainly extremely challenging for farmworkers and other people who are low-income and who may have seasonal jobs, not year-round, and have periods” when there is no work available, said Alexis Guild, vice president of strategy and programs at Farmworker Justice.
New requirements, additional obstacles
Agriculture is a trillion-dollar industry, and Americans depend on some 2.9 million farmworkers to put food on their tables. Nearly 60% of those workers are U.S. citizens or green card holders, according to the U.S. Department of Agriculture. The remaining 40% lack legal status or are not eligible for Medicaid.
Even among farmworkers with citizenship or legal status, the uninsured rate is three times that of the general population, and the majority of insured farmworkers are Medicaid recipients, although participation rates vary by state. According to a new analysis, between 71% and 79% of eligible farmworker households report participating in Medicaid.
New Medicaid work requirements were a key provision of the One Big Beautiful Bill signed last July by President Donald Trump. Under federal law, 43 states and the District of Columbia must implement the requirements by January 1. Some states have taken steps to implement the work rule early.
The 80-hour rule applies in states that expanded Medicaid, a process that began in 2014 and was tied to the Affordable Care Act. Following the initial expansions, farmworkers with legal documentation were 24% more likely to have health insurance, according to a 2021 article in the American Journal of Agricultural Economics.
Immigration anxieties
The work requirements are the latest in a long line of obstacles placed between workers and the health care to which they are legally entitled, Guild said. “Medicaid certainly helps because it alleviates the cost issue,” he said. “But there are still other barriers, such as transportation, sick leave, and finding time to visit a health center. All of these factors can prevent them from receiving medical care.”
For farmworkers with green cards and naturalized U.S. citizens, there is another source of stress: the fear that enrolling in Medicaid could put personal information in the hands of immigration authorities.
That's what worries Luis, a 45-year-old green card holder and Medicaid recipient who dreams of becoming a U.S. citizen. Luis, who asked to be identified only by his middle name, lives with his wife and daughter in North Carolina, where he has farmed for nearly a decade.
Speaking in Spanish, he said that when he learned about the job requirements, he knew it would be a challenge for him to prove that he works 80 hours a month. “I only work on farms for six or seven months; the rest of the year I work on what I can find,” he said.
Republicans in Congress argue that work requirements will reduce federal health care spending, encourage non-disabled adults to enter the workforce, and preserve safety net resources for the most vulnerable populations.
Among Hispanic adults enrolled in Medicaid, 67% are already working, according to a 2025 KFF report.
The Centers for Medicare and Medicaid Services did not respond to requests for comment for this article. But in June, when CMS announced its “nationwide framework” for implementing Medicaid work requirements, Administrator Mehmet Oz said it would help beneficiaries “develop skills and independence through work, education, job training or community service, creating new opportunities for themselves and their families.” Federal officials say the new requirements “could reduce poverty by up to 2.9 million people.”
Chronic illness
Agricultural work is one of the most dangerous occupations in the country and is associated with long-term health impacts and high rates of chronic diseases, including respiratory conditions. A 2021-22 California survey found that 37% of male farmworkers and 47% of female farmworkers in the state had at least one chronic health condition. The new work requirements present another barrier for those seeking care, advocates said.
“People are skipping checkups and screenings, and conditions that could be detected early and treated cost-effectively” are not, said Adriana Cadena, executive director of Protecting Immigrant Families.
Emergency rooms often become the “natural” place to go for medical care, Cadena added. “This increases wait times and costs for all of us…And when people are sick enough to miss work, it starts a vicious cycle of lost productivity and family economic instability that again threatens us all.”
A loss for families and children
The new federal rules also require recipients to verify their eligibility at least twice a year, twice as often as before, creating another potential hurdle.
“Letters are easy to miss and forms can go unfilled. If people get caught up in the paperwork, they could lose coverage,” said Akeiisa Coleman, associate vice president of The Commonwealth Fund, a nonprofit that promotes an equitable health care system.
For farmworkers traveling from state to state, the process can be especially difficult.
“You have to find the time to transfer your coverage and probably find a person or organization that can help you, and that can be very difficult when you're constantly moving,” Cadena said.
The situation highlights the difficulties of navigating a complex system for individuals and families already struggling to make ends meet.
“The result,” Cadena said, “could be the loss of coverage not only for workers, but also for their families and children.”
