A newly passed bill in the Senate, backed by President Donald Trump, could soon require millions of Americans to work or meet new qualifications in order to continue receiving health care or food assistance, with many at risk of losing benefits if they do not comply.

A federal budget bill backed by President Donald Trump and narrowly passed by the House of Representatives last Thursday could bring sweeping changes to major public assistance programs in the United States, particularly Medicaid and SNAP (food assistance).

If the bill becomes law, millions of low-income Americans could lose access to health coverage and food aid due to new work requirements and stricter eligibility guidelines. The Congressional Budget Office estimates that 8.6 million people could lose health coverage over the next decade under the proposal.

The bill would require most able-bodied adults under 65 to prove they are working, attending school, or volunteering in order to receive Medicaid coverage. Though 92% of Medicaid recipients already meet such criteria or are exempt due to disability, approximately 5 million people could fall through the cracks — either because they fail to report their compliance or don’t qualify for an exemption.

States that implemented similar requirements in the past saw sharp declines in enrollment. In Arkansas, the only state to fully enforce such a policy, more than 18,000 people lost coverage in 2018 before the program was halted by federal courts.

Critics warn that rural hospitals could be hit hard if patients lose Medicaid and are unable to pay for care. Eduardo Conrado, president of a major multi-state hospital network, cautioned that the changes represent more than just policy updates. “Adding work requirements is not just a policy change, it’s a shift away from the purpose of the program,” he said.

The bill would also expand work requirements for the Supplemental Nutrition Assistance Program (SNAP). Currently, adults ages 18–49 without dependents must meet work requirements. The new legislation would raise the age limit to 65 and apply it to parents with no children under age 7. Areas with high unemployment would no longer be exempt.

Analysts estimate that these expanded rules could put up to 6 million adults at risk of losing food assistance, with little evidence that similar policies in the past increased employment.