One unexplored issue is a loophole that allows individuals to satisfy the work requirement if their household has at least $580 of monthly income—which includes gross gambling winnings (i.e., the profits from winning bets or gambling sessions) without netting out losses. In most states, individuals can maintain Medicaid coverage by showing $580 in gross gambling winnings once every six months.

Individuals averse to the risk of losing money may still be able to exploit the loophole, by taking positions on both sides of a single bet that guarantees both $580 in winnings and a somewhat larger loss, satisfying the work requirement without any financial risk apart from covering modest bookmaker fees.