At least four states are pushing to implement work requirements for their Medicaid programs, and some lawmakers and officials have floated implementing requirements at the federal level.
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 the past. In 2023, House Republicans included work requirements in a bill to raise the debt ceiling. The requirements were later struck from the bill.
Russell Vought, Mr. Trump's nominee to direct the Office of Budget Management, told the Senate during a confirmation hearing he supports work requirements for the program, the New York Times reported Jan. 21.
At least four 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 fulltime 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.
Currently, Georgia is the only state with Medicaid work requirements in place. The program, which launched in 2023, grew slower than the state projected. There are 4,300 enrollees, the Georgia Recorder reported in July far from the state's estimate that 25,000 people would enroll in its first year.
Georgia Gov. Brian Kemp is proposing an amendment to the program that would allow parents of young children to receive Medicaid coverage without working, the Georgia Recorder reported Jan. 15.
Other states could also request to implement work requirements, according to KFF. In 2024, South Dakota voters approved a ballot measure to implement work requirements, though the state has yet to submit a waiver.
North Carolina expanded its Medicaid program in 2023. According to KFF, the legislation expanding the program includes a provision requiring the state to seek approval for work requirements if it is likely CMS would approve the request.
This story was first published Jan. 21 and updated Jan. 28 with more details.