Several Republican-led states are starting to craft Medicaid work requirement policies for next year that are stricter than required by law, making it tougher for able-bodied adults to remain on the social safety net program.
Several states with Republican governments, including Indiana, New Hampshire, Iowa, and others, are planning to do more than the minimum required under the One Big Beautiful Bill Act, signed by President Donald Trump last year, to implement work requirements for nondisabled Medicaid enrollees, according to a new state survey from the health policy group KFF.
Recommended Stories
Medicaid, the partially federally funded and state-administered health insurance program for low-income Americans, covers roughly 70 million adults and children nationwide and costs the federal government more than $900 billion annually.
Creating “community engagement” requirements for able-bodied adults on the program was a central feature of the law, which requires that able-bodied enrollees aged 19 to 64 work, be enrolled in school, or volunteer for at least 80 hours per month.
Republicans have long supported including work requirements for nondisabled Medicaid beneficiaries, saying that they serve as a program integrity measure to protect the social safety net for the “truly needy.”
Although able-bodied adults are eligible for Medicaid in 43 states that expanded enrollment through Obamacare, fiscal hawks often say this population is taking advantage of the system. But critics of work requirements say they inevitably will eliminate rightfully eligible enrollees because they will fall through the cracks of reporting systems.
States are feeling the time crunch to implement community engagement requirements by the January 2027 deadline, but a handful of GOP states are starting early to get the program integrity measure in full swing.
The new information on the states’ plans comes from KFF’s annual survey of Medicaid program officials, in partnership with the Georgetown University Center for Children and Families.
According to the survey, Nebraska was the first state to announce that it will implement its Medicaid work requirements before the statutory deadline. Medicaid beneficiaries in Nebraska will be required to start showing proof of eligibility by May 1.
Montana has indicated that it too will begin implementing work requirements early, starting July 1. Iowa has also said it will start its work requirement verifications early, but has not set a start date.
Medicaid beneficiaries in Arkansas will also see changes this summer, with the state opting to soft-launch its requirements on July 1, checking beneficiaries’ qualification status but not disenrolling individuals who do not meet the requirements until 2027.
A handful of GOP states are also opting to be stricter in enforcing enrollment qualifications than their counterparts, including withholding many exemption opportunities and doing more intense work history checks.
Indiana, for example, told KFF that it plans not to adopt any of the short-term hardship exceptions for work requirements given to states as an option under the OBBBA.
That means residents in Indiana who are in those categories, such as living in a county with high unemployment rates or being admitted to a hospital or nursing facility, will not be able to seek an exemption status under the Hoosier community engagement requirements.
Indiana is also obligated by state law to verify Medicaid eligibility every quarter instead of every six months. To do so, Indiana will check enrollees’ qualifications monthly to ensure they meet employment or community engagement requirements between verifications.
Iowa is also not planning to adopt any short-term hardship exemptions for enrollees or new applicants. Oklahoma and Missouri are not planning on taking into account an enrollee’s residence in a county with high unemployment to grant exemptions, but will allow for certain others, such as if the county experienced a natural disaster.
Although Idaho plans to adopt all optional hardship exemptions, it will also review three months of employment data for new Medicaid applicants and current beneficiaries to maintain eligibility.
The majority of states, including those where more than a quarter of their population is covered by Medicaid, such as California and Louisiana, reported in the KFF survey that they are looking to be more generous with short-term hardship exemptions and their verification timelines.
But many reported to KFF that they hope the Centers for Medicare & Medicaid Services, which oversees the implementation of federal Medicaid standards, will provide more guidance on best practices and highly technical questions.
MEHMET OZ PLEDGES HOSPICE FRAUD INVESTIGATIONS IN TEXAS
Multiple states in KFF’s focus group said they hope for additional guidance from the agency on the flexibility of income verification techniques and more standardized definitions for some of the exempt categories, such as “medically frail” enrollees.
Other states expressed interest in the survey for more guidance from CMS in building out their technological infrastructure, as well as human workforce, in time for the January deadline.
