New Medicaid Federal Work Requirements
Introduction to Medicaid Work Requirements
When President Donald Trump signed a law adding work requirements for some Medicaid recipients, he may have undercut lawmakers in at least 14 states who were designing their own plans, according to health industry observers.
States’ Pursuit of Work Requirements
Georgia is the only state with a work requirement in place for Medicaid, but several states have been pursuing such a policy for years, only to be blocked by courts or, most recently, the Biden administration. Some seek state-specific touches to the new rules. Others aim to implement work requirements before the federal law takes effect at the end of 2026.
Impact of Federal Law on State Plans
These states’ moves and Trump’s massive tax-and-spending law share one demand: To keep their Medicaid health coverage, adults who can work must prove they’re logging a minimum number of hours at a job or school, or else qualify for one of the few exemptions. But now, states that jumped ahead need to ensure their proposals, which require federal approval, don’t stray too far from Trump’s law.
Analysis of the New Federal Law
“The statute sets both the floor and ceiling” for work requirements, said Sara Rosenbaum, a health law and policy professor with George Washington University.
State Proposals and Federal Approval
South Dakota, for example, announced in July that it would not submit an application for work requirements as previously planned amid concerns that the state’s laxer rules would not be allowed under the new federal law. The state’s Department of Social Services secretary had warned that working on a state proposal while the federal rules are being hashed out could be “an exercise in futility.”
Examples of State Proposals
Arkansas’ plan, on the other hand, is more stringent than the federal law. There are no exemptions to its work requirements in the application, which is pending with the Centers for Medicare & Medicaid Services. Arizona’s proposal also includes something that’s not in the federal law: a ban on “able-bodied adults” receiving Medicaid benefits for longer than five years total in their lives.
Federal Guidance and State Waivers
Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, said the department is analyzing how the new federal standards interact with state waivers. The federal health department must release rules by next June that outline how states are to implement work requirements, according to Elizabeth Hinton, who has been tracking such waivers as part of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.
State-Specific Solutions
States can tweak their Medicaid programs through what are known as demonstration waivers, which are subject to federal approval. The waivers are designed to test new ideas in policy gray areas. The states that have filed or plan to file such applications with work requirements include Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Montana, New Hampshire, North Carolina, Ohio, South Carolina, South Dakota, and Utah.
Conclusion
In conclusion, the new Medicaid federal work requirements have introduced a new level of complexity for states seeking to implement their own plans. While some states may be able to tweak their proposals to align with the federal law, others may face challenges in getting their plans approved. As the federal government releases guidance on implementing work requirements, states will need to navigate the new rules carefully to ensure their plans are approved.
FAQs
Q: What are the new Medicaid federal work requirements?
A: The new federal law requires adults who can work to prove they’re logging a minimum number of hours at a job or school, or else qualify for one of the few exemptions, to keep their Medicaid health coverage.
Q: How do the new federal work requirements affect state plans?
A: States that have proposed their own work requirements need to ensure their plans don’t stray too far from the federal law, which sets both the floor and ceiling for work requirements.
Q: Which states have proposed work requirements for Medicaid?
A: The states that have filed or plan to file applications with work requirements include Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Montana, New Hampshire, North Carolina, Ohio, South Carolina, South Dakota, and Utah.
Q: What is the timeline for implementing the new federal work requirements?
A: The federal health department must release rules by next June that outline how states are to implement work requirements, and the new law takes effect at the end of 2026.
Q: Can states still propose their own work requirements?
A: Yes, states can still propose their own work requirements, but they need to ensure their plans align with the federal law and are approved by the federal government.
By Katheryn Houghton, Bram Sable-Smith, KFF Health News
KFF Health News correspondents Sam Whitehead and Lauren Sausser contributed to this report.
©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.
