Most states do not require you to work to receive Medicaid, but some have added work requirements in recent years

Medicaid work requirements vary by state. The federal government does not mandate work as a condition of Medicaid enrollment, but since 2018, the Centers for Medicare & Medicaid Services (CMS) has allowed states to impose their own work or work-related activity requirements through something called a "waiver." A handful of states have implemented these rules; most have not.

If you live in a state with a work requirement, you typically must work, volunteer, attend school, or participate in job training for a set number of hours per week — often 20 to 30 hours. If you do not meet the requirement, you can lose your coverage. However, many states have paused or rolled back these requirements due to legal challenges or policy changes, so the landscape shifts frequently.

The safest way to know whether your state has a work requirement is to contact your state Medicaid office directly or check your state's Medicaid website. Do not assume based on what you hear about another state — the rules are different in each one.

Key Takeaways

  • Work requirements are not a federal Medicaid rule; they exist only in states that have chosen to add them through a waiver.
  • States that do impose work requirements typically ask for 20 to 30 hours per week of work, volunteering, school attendance, or job training.
  • Many exemptions exist, including for people over 65, people with disabilities, pregnant people, and caregivers of young children.
  • Your state Medicaid office can tell you whether a work requirement applies to you and what activities count toward the requirement.
  • Work requirements have been paused or repealed in several states, so the rules in your state may have changed recently.

Which states currently have work requirements

As of 2024, several states have implemented or attempted to implement Medicaid work requirements, though the number and status change as courts rule and administrations shift policy. States that have had work requirements in place or proposed them include Arkansas, Indiana, Kentucky, New Hampshire, Ohio, and others. However, some of these have paused or ended their programs due to legal challenges or administrative decisions.

Because the status of work requirements is fluid, you cannot rely on a list from an article to tell you what applies to you right now. Your state Medicaid program is the only source that can confirm whether a requirement is currently in effect and whether you are subject to it. You can find your state Medicaid office by searching "[your state] Medicaid" or by calling 211, which connects you to local health and human services information.

Who is exempt from work requirements

States that impose work requirements build in exemptions for groups that are not expected to work. These typically include people age 65 and older, people with disabilities or serious medical conditions, pregnant people, people caring for a child under age 6, and people experiencing homelessness. Some states also exempt people in school full-time or people with temporary medical conditions.

The exact list of exemptions depends on your state's waiver. If you think you may be exempt, your state Medicaid office can review your situation and tell you whether the requirement applies to you. You do not have to guess — ask them directly.

What counts as meeting the work requirement

Work requirements are not limited to paid employment. States typically accept several types of activities as meeting the requirement, including unsubsidized employment (a regular job), subsidized employment (a job where the state or an employer covers part of your wages), self-employment, volunteering, job training or education programs, and participation in work-related services like resume writing or job coaching.

The number of hours required per week varies by state — some ask for 20 hours, others for 30. Some states count multiple activities toward the total: for example, 15 hours of work plus 10 hours of job training might satisfy a 25-hour requirement. Your state Medicaid office can tell you exactly what activities count in your state and how many hours you need.

How work requirements affect your coverage

If your state has a work requirement and you do not meet it, you will lose Medicaid coverage. The loss is not permanent — you can regain coverage by meeting the requirement in a future month or by falling into an exempt category. However, losing coverage means you have no health insurance during that time, which can be costly if you need medical care.

Some states have reporting systems where you must document your work or activities each month. Others use data from employers or training programs to verify compliance. If you are unsure how your state tracks this, ask your Medicaid caseworker or your state Medicaid office when you enroll or renew.

Recent legal and policy changes affecting work requirements

Work requirements have faced legal challenges in federal court. In 2020, a federal judge blocked Arkansas's work requirement, and other states have faced similar lawsuits. Additionally, the Biden administration issued guidance in 2021 suggesting that work requirements may conflict with the purpose of Medicaid, and several states have voluntarily paused or ended their programs as a result.

This means that even if your state had a work requirement in the past, it may no longer be in effect. Conversely, a state without a requirement could add one in the future. The only reliable way to know the current status is to check with your state Medicaid program or visit your state's Medicaid website.

How to learn about your state has a work requirement

Start by contacting your state Medicaid office. You can find the phone number by searching "[your state] Medicaid contact" or by calling 211. When you call, ask directly: "Does my state have a Medicaid work requirement, and does it explore to me?" Have your age, income, and household situation ready so they can give you an accurate answer.

You can also visit your state's Medicaid website, which usually has a section on work requirements if one exists. If the website is unclear, call — it is faster and more reliable than trying to interpret policy documents on your own.

Frequently Asked Questions

What happens if I lose my job and cannot meet the work requirement?

Contact your state Medicaid office right away. Many states allow a grace period or accept job training, volunteering, or other activities as temporary substitutes while you search for work. Some states also have exemptions for people experiencing hardship. Do not wait — the sooner you report the change, the more options you may have.

Does Medicaid work requirement explore to people receiving disability benefits?

No. People who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) are typically exempt from Medicaid work requirements. However, if you receive Medicaid through a different pathway, the requirement may explore. Ask your state Medicaid office to confirm your exemption status.

Can I count school or job training toward the work requirement?

Many states do allow school or job training to count, but the rules vary. Some states require a combination of work and training, while others accept full-time school as meeting the requirement. Ask your state Medicaid office whether your specific school or training program counts and how many hours per week it must be.

If I move to a different state, do I have to meet a new work requirement?

It depends on the state you move to. Each state sets its own rules. When you move, contact your new state's Medicaid office to find out whether a work requirement applies there. Do not assume it is the same as your previous state.

How do I report my work hours or activities to meet the requirement?

The reporting process varies by state. Some states use an online portal, others require monthly phone calls or in-person visits, and some receive reports directly from employers or training programs. Your state Medicaid office will explain the process when you enroll or when the requirement begins to explore to you.