By Bridget Early / October 28, 2026
The Centers for Medicare and Medicaid Services is offering states mitigation strategies as they hustle to implement Medicaid work requirements by the Jan. 1 deadline.
CMS has created checklists of mitigation strategies states can choose to implement as they race to complete their work requirement verification systems. Starting next year, most working-age adults without disabilities must prove they work, volunteer or go to school for at least 80 hours a month to qualify for Medicaid.
States seeking flexibility from CMS will need to identify actions that may not be complete before the deadline, explain how they intend to resolve those problems and offer alternative implementation timeframes, according to the memo CMS sent to states. CMS will conduct its own analyses and approve flexibilities or offer enforcement discretion.
State officials have warned that tight timelines and hefty operational workloads would make implementation highly difficult by Jan. 1.
CMS characterized the mitigation planning as a part of the normal process of standing up complex new policies.
“Any major implementation should include a plan for launch, readiness reviews, steps to address identified risks and a clear understanding of federal and state responsibilities. That is the expectation, and this work is part of that preparation,” a CMS spokesperson said in a statement. “These reviews help CMS understand each state’s readiness, identify where additional support is needed before launch, and plan for continued assistance afterward as states improve their technology, automation and operations.”
Medicaid work requirements are one of the signature policies from President Donald Trump’s tax law, so the political stakes are high for the administration.
There are pitfalls and states may not be ready, however, said Matt Salo, CEO of the consulting firm Salo Health Strategies and former executive director of the National Association of Medicaid Directors.
“This is where the rubber hits the road, and as much as you want things to be a certain way, the timetables that were built into the statute just were incompatible with getting something this complex up and off the ground in a bunch of different states,” Salo said.
The CMS memo, which consists of three checklists, lays out areas for which states may require flexibility. States may need to update their mitigation plan as implementation evolves, the guidance says. Washington Post Intelligence first reported on the document.
The first checklist focuses on difficulties states are encountering as they prepare to meet work requirements, coupled with mitigation strategies states could adopt.
This includes challenges such as an inability to fully update application and renewal forms, a lack of reliable data sources to confirm enrollees are meeting requirements, or an inability to confirm whether enrollees are eligible for exemptions.
CMS offers mitigation strategies such as recommending states permit self-attestation as a verification option, conduct manual claims reviews and carry out post-enrollment verifications of whether a beneficiary qualifies for an exclusion from work requirements, such as being a primary caregiver to a child younger than 13.
The second checklist focuses on challenges states may have with underlying enrollment processes, such as application, renewal and fair hearing procedures.
The third offers optional strategies states can implement to address “significant operational and systems challenges” as they arise, such as using income information from other government programs to check Medicaid eligibility.
States will need to follow their mitigation plans, once approved, to avoid penalties, CMS wrote in its guidance. States must submit quarterly updates and provide timelines for reaching full compliance.
Several of the proposals offer meaningful flexibility, according to an analysis from Manatt Health. For instance, states that have decided to use longer eligibility review periods, such as a three-month lookback, could temporarily employ a one-month review period.
But other policies won’t be enough to meaningfully ensure eligible individuals retain coverage, according to Manatt Health. For example, directing people to call centers won’t resolve missing work reporting questions on paper applications.
“Some mitigation strategies will simply be out of reach for states by Jan. 1, 2027,” the Manatt Health reports says. “These limitations underscore the importance of CMS considering broader flexibility to delay disenrollments while states put the necessary coverage protections in place.”