Washington is bringing back Medicaid work requirements, and the mechanism is straightforward: states that receive federal waiver approval can require able-bodied adults to document employment, job training, or community service hours to maintain coverage. When enrollees can't or don't comply — whether from paperwork burden, part-time status, or gaps in verification — they disenroll. Fewer members means fewer per-member-per-month (PMPM) capitation payments flowing to managed care organizations (MCOs). The policy catalyst doesn't touch Medicare Advantage or commercial insurance; it carves into Medicaid managed care, which is a meaningful revenue line for several large insurers.