At least 11 states are considering 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 eleven states are pursuing Medicaid work requirements. Three states, Arkansas, Arizona and Ohio, have submitted waiver requests to CMS, though these programs have yet to be approved, according to KFF. Georgia is the only state with an active work requirement as of April 2025.
Here are eleven updates to know:
- In March, North Carolina legislators introduced a bill that would authorize the “expedient implementation” of Medicaid work requirements.
- Indiana lawmakers approved a bill adding work requirements to the state’s Medicaid program April 8, the Indiana Capital Chronicle reported.
- 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 March, the Ohio Senate adopted a resolution urging the president to approve the request.
- Iowa legislators approved a bill to require adults ages 19 to 64 to work at least 80 hours a month to qualify for Medicaid benefits, the Iowa Capital Dispatch reported March 25, though a final amended version of the bill has yet to be passed by the state’s senate. Iowa Gov. Kim Reynolds has directed the state to submit a request for a federal waiver to HHS independent of the legislature, according to the outlet.
- 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 legislature overrode a veto by Gov. Andy Beshear to pass the law, Louisville Public Media reported March 27.
- 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. Gov. Brad Little signed the bill into law March 19, the Idaho Capital Sun reported.
- 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 originally published Jan. 21 and most recently updated April 14.
