We don’t usually write a blog like this that dissects the flawed methodology of the Foundation for Government Accountability (FGA) – a right-wing group that is well known for promoting work reporting requirements at the state and federal level – as well as cuts to Medicaid and the safety net more broadly. FGA’s own annual report takes credit for developing the strategy and putting “boots on the ground” in 2022 to set the stage for enacting nearly $1 trillion in Medicaid cuts in H.R. 1, which were a thinly veiled attempt to seriously undermine the Affordable Care Act’s Medicaid expansion – a crucial component of the ACA’s efforts to move the U.S. toward universal coverage.
A recent editorial titled “Medicaid needs stronger work requirements” by The Washington Post comes right from FGA talking points (and links only to FGA-related sources). This reveals two things: The Washington Post’s editorial board loses credibility as a neutral, fact-based arbiter by relying solely on FGA, and the time has come to refute this propaganda. Ironically, in 2023, reporters from The Washington Post’s reporting staff wrote a very thorough piece on FGA’s funding and methods of operation detailing the organization’s efforts to weaken child safely laws.
Let’s take a closer look at the FGA report that The Washington Post likely relies on to form the basis of its editorial. The main argument is that Medicaid work reporting requirements (WRR) need to be tightened up because, according to FGA, 59 percent of nondisabled adults enrolled in Medicaid did not work at all in 2024. As readers of CCF’s “SayAhhh! Health Policy Blog” know, the Congressional Budget Office projected that 5.3 million people would lose Medicaid due to the WRR in H.R.1; the interim final rule implementing WRR went beyond what is in the law as we have explained elsewhere on the definition of medical frailty.
FGA’s “finding” of 59 percent cited by The Washington Post editorial is almost the mirror opposite to conclusions reached in three different studies by researchers at KFF, the Center on Budget and Policy Priorities, and the Urban Institute. All find that approximately two-thirds of Medicaid enrollees who are non-elderly adults and not receiving disability benefits are working. And, a new study from researchers at Boston University and the University of South Carolina published last month in JAMA Health Forum estimates once again that about two-thirds of adults covered by Medicaid and potentially subject to WRR are working.
What has previous research found and why do we consider that more reliable? Analyzing data from the Census Bureau’s Current Population Survey (CPS), KFF researchers found that in 2023, 64 percent of non-elderly adults covered by Medicaid were working on a full-time (44 percent) or part-time basis (20 percent), after excluding non-elderly adults receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits and those also covered by Medicare. 12 percent of adult Medicaid enrollees did not work due to caregiving responsibilities, 10 percent did not work due to disability or illness, and 7 percent did not work as they were in school. Only 8 percent were not working due to retirement, inability to find work, or other reasons. The Center on Budget and Policy Priorities (CBPP) obtained near-identical results for 2023 also analyzing CPS data. Finally, using CPS data for 2023-2025, Boston University and University of South Carolina researchers find in their JAMA Health Forum paper that 66.6 percent of Medicaid enrollees potentially subject to WRR were participating in the labor force.
Based on a different data source and focusing on a more limited group, the Urban Institute estimated the number of working Medicaid expansion enrollees without children, using three years of Census data (2017-2019) from the Survey of Income and Program Participation (SIPP). Among non-elderly adults in Medicaid expansion states who are enrolled in Medicaid but are not parents or guardians of dependent children and are not receiving SSI, SSDI, or Medicare, 69 percent worked or attended school.
How does FGA justify such different results? The Washington Post editorial does not cite to a specific FGA analysis, referencing only new estimates from FGA. They seem to be an update or otherwise derived from an earlier FGA paper from March 2025 (with 2022 data). That paper tries desperately to dismiss the KFF estimates as the product of “[r]adical leftist groups” and a “lie.” It’s never a good sign when name-calling is your primary methodological criticism.
KFF, CBPP, the Urban Institute, and the Boston University and University of South Carolina researchers are all transparent with their methodology, rely on publicly available federal survey data sources, and produce findings that are consistent with each other. In contrast, the FGA analysis is based on “data provided by state Medicaid agencies in 23 states with responsive records on the number of non-disabled adults between the ages of 18 and 64 enrolled in Medicaid in 2022 and the number of those adults with no earned income.” FGA claims this “dataset covers individual earnings for nearly 21 million able-bodied adults on Medicaid.”
FGA does not make this data available. It does not explain what the record requests were, including the specific data questions. It does not elaborate about how non-disabled adults are defined. It does not explain what records were considered responsive and whether the data responses were complete or comparable across states (unlike federal survey data).
Crucially, FGA does not explain how the data from responding states is adjusted and then extrapolated to the national level, with only some states responding. A number of responding states are large non-expansion states that do not offer Medicaid to most adults but cover parents who meet very, very low-income eligibility levels (e.g., Florida and Texas). These eligibility levels are so low — Florida is 26 percent of the federal poverty line (FPL) or $592 in monthly income for a family of three and Texas is 15 percent FPL or $342 in monthly income for a family of three — that by definition these parents are not working much, if at all – or they would not be eligible. As a result, based on the lack of transparency and the implausible results, one simply cannot view these FGA estimates as credible.
In short, this FGA report is heavy on footnotes (which generally are footnotes to other things they have written) but completely lacking on transparency about their data and their methodology. To come up with such different results from multiple existing credible analyses that are transparent about their methods with replicable results requires far more transparency to have any credibility. In light of FGA’s history and vantage point, this is a case of propaganda by any other name. It is a shame that The Washington Post’s editorial board fell for it.