New Medicaid federal work requirements mean less leeway for states
As President Trump signed a law implementing work requirements for some Medicaid recipients, it has sparked a ripple effect across states that were in the process of designing their own plans. Georgia currently stands as the only state with a work requirement in place for Medicaid, but several others have been actively pursuing similar policies for years. However, these efforts have faced roadblocks from courts or the Biden administration, pushing them to align with the new federal law.
States like South Dakota have put a pause on their plans for work requirements due to concerns about compliance with the federal standards. On the other hand, Arkansas has proposed even stricter regulations than the federal law, with no exemptions in their application. Arizona has also included a unique provision in their proposal, limiting “able-bodied adults” from receiving Medicaid benefits for more than five years in their lifetime.
Federal officials are now analyzing how the new federal standards intersect with state waivers. States can seek approval for waivers to modify their Medicaid programs, with several states like Arizona, Arkansas, Georgia, Idaho, and others already in the process of filing applications. While Congress has left room for states to fast-track national standards through waivers, the approval process remains uncertain.
Montana is the first state to draft a waiver application since the implementation of national work requirements, aligning largely with the federal law but also introducing additional exemptions. South Carolina, a state that has not expanded Medicaid eligibility under the Affordable Care Act, has submitted a request for a partial expansion with work requirements that align with federal standards.
In the midst of these changes, Georgia’s “Pathways to Coverage” program faces uncertainty as it seeks an extension with modified requirements. The state awaits guidance from the federal government on potential alterations to their plan. With states like Georgia in limbo, the future of Medicaid work requirements remains a complex and evolving landscape.
This article was contributed by KFF Health News correspondents Sam Whitehead and Lauren Sausser, highlighting the ongoing developments in Medicaid work requirements across various states. KFF Health News is a national newsroom dedicated to in-depth journalism on health issues and operates as part of KFF, an independent source for health policy research, polling, and journalism.
