Map Shows Latest Medicaid Work Requirements Across US

By Jasmine Laws / May 14, 2025

House Republicans are renewing their push for Medicaid work requirements through new legislation that would compel certain recipients to complete monthly "community engagement" activities, like working, studying, or volunteering, to retain their health benefits.

The proposal, long championed by conservatives and supported by President Donald Trump during his first term, represents a significant shift in how the federal government supports low-income adults without dependents.

Why It Matters

The bill instructs the committee to reduce the Department of Health and Human Services budget by $880 billion over 10 years. Critics warn this will substantially weaken the Medicaid system, the largest public health insurance program in the country, by forcing millions off the service.

Supporters of the plan, however, argue that work requirements will foster employment, reduce fraudulent claims, and improve personal responsibility.

What To Know

The legislation, part of a broader budget reconciliation bill passed by the House in April, is now under review by the House Committee on Energy and Commerce.

It mandates 80 hours of verified community engagement per month for able-bodied Medicaid recipients aged 19 to 55. The proposed reforms also include enhanced eligibility checks and significant cost shifts from the federal government to the states.

The reform bill revives a model from the first Trump administration, in which work requirements were approved for some states but later blocked by courts. In 2018, over 18,000 people in Arkansas lost Medicaid coverage before judges ruled the policy contradicted Medicaid's mission.

The Congressional Budget Office estimates that the current proposal would save the federal government $109 billion over a decade but would result in approximately 6000,000 people losing coverage and shift $65 billion in costs to state governments.

Other key provisions include semi-annual income verification checks, up from the current annual reviews, and a reduction in the federal match rate for Medicaid expansion populations from 90 percent to a range between 50 to 83 percent, increasing states' financial burden.

U.S. States With Medicaid Work Requirements or Requirement Legislation in Progress

Fourteen states currently either have approved Medicaid work requirement legislation or have such policies in process.

States With Federally Approved Medicaid Requirements

Georgia is the only state that has Medicaid work requirements in place, according to the Kaiser Family Foundation (KFF). The rule was implemented in July 2023, and expires in September 2025, and the state is looking to renew the policy.

In the state, Medicaid applicants must complete a minimum of 80 hours of qualifying activities before Medicaid coverage begins.

States With Medicaid Requirements Pending

Arizona is looking to bring in legislation where individuals would be required to fulfill certain work-related or qualifying activities for at least 20 hours per week for Medicaid support. There would also be a one-year ban for individuals who "knowingly" fail to report a change in family income or who make false statements regarding their work status.

The state is currently seeking an amendment to be made to its Arizona Health Care Cost Containment System (AHCCCS) 1115 waiver to implement the change.

Arkansas is also waiting for the approval of an amendment to be made to its existing policy that would require Medicaid recipients to be assessed by the state to determine whether they are "on track" or "not on track" toward meeting "personal health and economic goals."

Ohio has also proposed a new 1115 waiver, that would condition Medicaid expansion coverage on meeting work requirements.

State-Level Legislation For Medicaid Requirement

Legislation seeking federal approval for implementing Medicaid work requirements has been adopted in a number of states including: Idaho, Indiana, and Kentucky.

Similar legislation in Missouri is awaiting state Senate approval, and in Montana, a policy signed by the state's governor will seek federal approval for Medicaid work requirements. Legislation is also under way in North Carolina and South Dakota.

States With Medicaid Requirements Released For Public Comment

Iowa, South Carolina and Utah are all wishing for amendments to be made to their state policies regarding Medicaid work requirements and each are still at the public comment stage of the process.

In Iowa, the state public comment period is open until May 15, while in South Carolina it will continue until May 31, and in Utah the period ends on May 22.

What People Are Saying

Dr. Susan Dorr Goold of the University of Michigan, told Newsweek: "They seem logical, but most able-bodied Medicaid enrollees already work. Sometimes their employment is not reliable, for example, in restaurants or tourism. The data show that work requirements increase costs by adding bureaucracy, have no effect on employment, and disenroll eligible people who don't navigate the bureaucratic requirements correctly."

Jamila Michener, Associate Professor of Government and Public Policy at Cornell University, previously told Newsweek: "Medicaid work reporting requirements are an ineffective policy mechanism that achieves little except to create barriers to healthcare access.

"Work requirements have already proven to be a failed policy that produce no discernable benefit. There is growing evidence of the harms of work reporting requirements including cutting off access to health care, driving up uninsured rates, increasing the burden of medical debt, and a range of other adverse consequences.

"Work reporting requirements create administrative burdens for already vulnerable populations. They also create confusion and unwarranted disenrollment from Medicaid, as people often don't know about them, causing perfectly eligible beneficiaries to lose benefits simply due to lack of information."

Professor Michener added that the "harmful effects" of work requirements "are concentrated among Black Medicaid beneficiaries, making the policy a driver of inequality."

What Happens Next

The Energy and Commerce Committee is expected to begin its review of the legislation this week.