At least nine states are pushing to implement work requirements for their Medicaid programs.
President Donald Trump backed Medicaid work requirements during his first administration. During Mr. Trump’s first term in office, 13 states chose to implement work requirements in their Medicaid programs according to KFF. The Biden administration later withdrew these waivers.
Lawmakers have proposed implementing work requirements at the federal level. In February, federal lawmakers introduced a bill that would require able-bodied Medicaid recipients to work or volunteer 20 hours a week to receive benefits. The bill has yet to be discussed in committee.
In 2023, House Republicans included work requirements in a bill to raise the debt ceiling. The requirements were later struck from the bill.
If work requirements were implemented at the federal level, up to 5 million adults could lose their Medicaid coverage by 2026, according to a report from the Robert Wood Johnson Foundation.
At least nine states are pursuing Medicaid work requirements:
- Arkansas Gov. Sarah Huckabee Sanders submitted a request to CMS to implement work requirements for all able-bodied, working-age adults receiving Medicaid benefits. Under the proposal, beneficiaries would be required to work, participate in school or vocational training or be a full-time caregiver. According to the waiver, submitted Jan. 28, Medicaid beneficiaries who are not employed or participating in another qualifying activity will be suspended, not removed from the program.
- South Carolina Gov. Henry McMaster submitted a waiver to CMS Jan. 21 requesting the agency allow the state to reimplement work requirements approved during the first Trump administration.
- Ohio will submit a request to CMS to implement work requirements for individuals under 55 in its Medicaid program. The state estimates 61,000 people could lose coverage under the requirement, the Columbus Dispatch reported Jan. 16.
- In a Jan. 14 address, Iowa Gov. Kim Reynolds said she will ask state officials to request federal permission to implement work requirements in the state’s Medicaid program. Legislators have advanced a bill that would implement work requirements, the Des Moines Register reported March 6.
- Missouri lawmakers proposed an amendment to the state’s constitution that would require Medicaid beneficiaries to complete 80 hours a month of work, education, job search or other qualifying activities, the Missouri Independent reported Feb. 19.
- The New Hampshire senate approved a bill that would add work requirements to the state’s Medicaid program, the New Hampshire Bulletin reported March 12. The state’s House of Representatives has yet to approve the bill.
- Kentucky lawmakers passed a bill adding work requirements to the state’s Medicaid program for adults receiving benefits for more than a year, the Lexington Herald-Leader reported March 15. The bill is awaiting Gov. Andy Beshear’s signature.
- Idaho lawmakers passed legislation aimed at transitioning the state’s Medicaid program to a managed care system while introducing work requirements for able-bodied adults.
- Arizona’s Medicaid program is seeking public comment on a proposal to institute work requirements for able-bodied adults 19 to 55 years old and a lifetime limit of five years for Medicaid benefits. The proposal is open for comment until March 20.
This story was first published Jan. 21 and updated Jan. 28 and March 19 with more details.
