Twenty-one thousand, six hundred low-income Virginians will lose their health insurance when the state implements a Republican-backed rule mandating that Medicaid enrollees must either be employed or prove that they are trying to get a job in order to keep their coverage, according to the state’s fiscal impact statement.

The work requirement rules were critical in reversing years of Republican opposition to expanding the state’s Medicaid program. Without conditions, Virginia Democrats would not have been able to persuade enough conservatives to expand Medicaid, a government program to provide healthcare to low income groups.

So, in a compromise, Virginia Democrats traded work requirements to get Medicaid expansion done in 2018.

But while Medicaid expansion in Virginia is well underway, with nearly 300,000 new enrollees, the rules stipulating that applicants must work or show they are trying to work in order to qualify are not yet in effect.

The Virginia Department of Medical Assistance Services and the federal government are currently negotiating the final details of a work requirements waiver, and an agreement is on track to be finalized this summer. Once the rules go into effect, thousands of Virginians who can get Medicaid today will be disqualified.

Healthcare advocates are calling on Republicans to re-examine what exactly the state is committing to by implementing a rule that will increase the state’s healthcare coverage gap. By its own estimate (calculated before the Medicaid roll out), 21,600 Virginians will lose coverage when the work requirements kick in. Health advocates worry losses will be larger than previously estimated and are calling for the state to reassess the impact of work requirements on enrollment.

Advocates point to the failure of Medicaid work requirements in other states as proof that these policies help nobody and hurt many.

Since becoming the first state to implement Medicaid work requirements last year, Arkansas has seen a spike in its uninsured rate. And a new study published in the New England Journal of Medicine found Arkansas’ work requirements had no discernible effect on employment.

This year, Montana set a guard rail on its work requirements, codifying that a dip of more than 5 percent loss in the coverage population would trigger a reevaluation of the program. The expected coverage loss in Virginia is more than three times that, at 18 percent.

In Maine, the legislature withdrew its application for work requirements, acquiescing to the notion that providing educational opportunity and healthcare without conditions is a more effective way to lift people out of poverty and into the workforce.

There are also ongoing questions over the legality of these work requirements. In March, a federal judge ordered Arkansas and Kentucky to halt their Medicaid work requirements programs over concerns that they violate the mission of Medicaid — to ensure access to healthcare.

A state can back out of a waiver at any time, but that’s not likely to happen in Virginia unless Democrats win big in the November General Assembly elections.