Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Washington

Medicaid work requirements in Washington: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Washington expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 559,113 of them (11.8% of an expansion pool of 597,699) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 138,417 people in Washington lose coverage by 2034: 121,643 of them still eligible but lost to paperwork and reporting failures, and 16,773 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Washington scores 81 of 100 on this model's ex parte capability index, a low band; its eligibility system is HBE / ProviderOne.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureWashington
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)597,699
Adults subject, strict definition559,113
Adults subject, permissive definition547,930
Share of expansion pool subject11.8%
Projected coverage loss by 2034138,417
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)81 (low)

Who is subject in Washington

Of the 559,112 subject adults, 35% already work 80 or more hours a month and 55% are not working. 32% have a child under 14 at home. Among those not working, 53% report a disability and 15% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2414%
Age 25-3423%
Age 35-4422%
Age 45-5417%
Age 55-6424%
Not working55%
1 to 19 hours a month1%
20 to 79 hours a month8%
80 or more hours a month (meets the bar)35%
Not working: Disabled53%
Not working: Caregiver15%
Not working: Postpartum0%
Not working: Student4%
Not working: Other28%

Why eligible people lose coverage

Of the 138,417 projected to lose coverage in Washington, 121,643 meet the requirement or qualify for an exemption but fail to document it. 49,540 of those are working people who cannot prove their hours through data the state can see, and 72,103 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Multiple part-time jobs (aggregation failure)14,376
Variable shifts / on-call work10,685
Self-employed (other)9,992
Full-time students not auto-verified4,399
Seasonal: agriculture, hospitality, food service3,529
Cash-paid construction & trades2,365
Gig / courier (DoorDash, Uber, Lyft, Instacart)2,130
Volunteering / job training2,062
Medically frail without auto-match30,830
Caregivers of a disabled adult18,021
American Indian / Alaska Native (tribal exemption)7,524
Parent caregivers of children ≤13 without auto-match5,964
SUD treatment not flagged in claims data4,200
Kinship caregivers (non-parent) of children ≤132,567
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)1,443
Recent incarceration (data-match gap)1,308
Pregnancy / postpartum data lag245

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (91% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Washington's composite score is 81 (low band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite81
Observed ex parte91
Core capability96
Data sources80
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four193,54134.6%
Working ≥ qualifying hours / income95,48817.1%
Medically frail94,01916.8%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1365,86911.8%
Parent caregiver of child ≤1337,9776.8%
Full-time student24,2934.3%
Working ≥ qualifying hours / income + Full-time student18,7263.4%
Working ≥ qualifying hours / income + Medically frail8,2011.5%

Counties in Washington

Subject adults concentrate: King County (150,985), Pierce County (62,633), and Snohomish County (57,622) account for 49% of the state's subject population.

All 39 counties in Washington with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
King County150,98510.1%37,3798.0%1,496,202
Pierce County62,63311.0%15,5069.0%568,391
Snohomish County57,62211.0%14,2658.0%524,620
Spokane County39,82712.1%9,86012.0%328,482
Clark County37,51412.2%9,2879.0%307,878
Thurston County20,95911.8%5,1899.0%177,616
Kitsap County20,05112.1%4,9648.0%165,828
Yakima County19,24513.6%4,76416.0%141,767
Whatcom County19,15113.6%4,74113.0%140,443
Benton County16,06613.3%3,97711.0%120,968
Skagit County10,29014.1%2,54812.0%72,896
Cowlitz County8,63113.5%2,13712.0%63,752
Grant County7,90714.0%1,95714.0%56,662
Franklin County6,94512.3%1,71913.0%56,534
Island County6,78414.2%1,6797.0%47,743
Clallam County6,64016.8%1,64411.0%39,631
Lewis County6,63213.9%1,64212.0%47,674
Chelan County6,49814.6%1,6099.0%44,436
Grays Harbor County6,17514.3%1,52915.0%43,100
Mason County5,66415.1%1,40213.0%37,570
Walla Walla County4,97914.0%1,23311.0%35,562
Whitman County4,85715.3%1,20324.0%31,744
Kittitas County4,43814.8%1,09914.0%29,932
Stevens County4,04516.0%1,00113.0%25,246
Okanogan County3,59515.2%89019.0%23,646
Douglas County3,57814.4%8868.0%24,775
Jefferson County3,16619.8%78414.0%15,990
Pacific County2,06916.9%51213.0%12,270
Klickitat County2,01215.4%49814.0%13,104
Asotin County1,77714.6%44016.0%12,165
San Juan County1,70018.1%42111.0%9,374
Adams County1,62415.2%40221.0%10,664
Pend Oreille County1,31817.8%32613.0%7,390
Skamania County1,05414.7%2619.0%7,168
Lincoln County1,03217.6%25612.0%5,857
Ferry County65917.3%16316.0%3,816
Wahkiakum County42719.2%10614.0%2,225
Columbia County34216.2%859.0%2,108
Garfield County21817.5%5411.0%1,246

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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