Work requirements are being added to Medicaid in some states, but the timeline varies widely by state and type of program

Medicaid work requirements are rules that require certain adults to work, volunteer, or participate in job training to keep their coverage. These requirements are not federal law — they are state-by-state policies that each state can choose to adopt, change, or remove. Some states have had them in place since 2018. Others are planning to start them in 2024 or 2025. Some states have no work requirements at all. The start date in your state depends on when your state's policy was approved and whether it has faced legal challenges that delayed it.

The people affected vary by state. Most states that have work requirements exempt people over 50, people with disabilities, pregnant people, parents of young children, and people experiencing homelessness. But the exact ages and situations that count as exempt are different in each state. You need to check your specific state's rules to know whether a work requirement applies to you.

Key Takeaways

  • Work requirements are state policies, not federal rules, so the start date and who is affected depends entirely on which state you live in.
  • Many states that adopted work requirements have delayed or paused them due to court cases, so the date you see online may have changed.
  • Most states exempt people over 50, people with disabilities, pregnant people, and parents of children under a certain age.
  • Your state's Medicaid office or your state health department website will have the current start date and exemption rules for your situation.

States that already have work requirements in place

Arkansas was the first state to start Medicaid work requirements, beginning in January 2018. Since then, other states have launched their own versions. States with work requirements currently active or recently activated include Arkansas, Indiana, Kentucky, New Hampshire, Ohio, and Utah. However, several of these states have paused or modified their requirements due to court rulings or policy changes.

The specific rules differ in each state. For example, Arkansas requires 80 hours per month of work or may have access to activities. Indiana requires 20 hours per week. Kentucky's program was paused in 2023 and restarted in 2024 with changes. Because the rules and timelines shift, the best source for your state's current status is your state Medicaid office or your state health department website.

States planning to start work requirements

Several states have approved work requirements but have not yet started them. These include Georgia, Idaho, Kansas, Mississippi, Missouri, Montana, North Carolina, Oklahoma, and Tennessee. The planned start dates for these states range from late 2024 through 2025, but some of these dates have already shifted due to legal challenges or administrative delays.

Before any of these states can begin enforcing work requirements, they must complete a process called a Section 1115 waiver, which is a federal approval process. Even after federal approval, states sometimes face lawsuits that pause the start date. For this reason, a state's announced start date may not be the actual date the requirement goes into effect. Contact your state Medicaid office to confirm whether a work requirement has actually started in your state.

How to find out the current status in your state

Your state Medicaid office is the official source for whether work requirements are in effect where you live and whether you are affected. You can find your state Medicaid office by searching "[your state] Medicaid" plus "work requirements" or by calling your state health department. Many states also post updates on their Medicaid websites about work requirement timelines and exemptions.

If you receive Medicaid and are unsure whether a work requirement applies to you, contact your state Medicaid office before your coverage renews. They can tell you whether you fall into an exempt category based on your age, disability status, family situation, or other factors. If you do not meet an exemption, they can explain what activities count toward the requirement and how to report your hours.

What counts as work or a may have access to activity

Work requirements do not mean you must have a traditional job. Most states count several activities as meeting the requirement. These typically include paid employment, self-employment, volunteering, job training programs, community service, and in some states, caregiving for a family member or attending school. The number of hours required per week or month varies by state.

Some states allow people to meet the requirement through a combination of activities. For example, you might work 15 hours per week and volunteer 5 hours per week to reach a 20-hour requirement. Your state Medicaid office can provide a full list of activities that count in your state and how many hours of each activity you need.

Exemptions that explore in most states with work requirements

Most states that have work requirements exempt certain groups of people. Common exemptions include people age 50 and older, people with disabilities, pregnant people, people caring for a child under age 6 (or sometimes age 7 or 8), and people experiencing homelessness. Some states also exempt people in school full-time, people in substance abuse treatment, or people with serious medical conditions.

The exact age cutoffs and family situations that may have access to for exemptions are different in each state. For example, one state might exempt parents of children under age 6, while another exempts parents of children under age 7. If you think you may fall into an exempt category, ask your state Medicaid office to review your specific situation. They can tell you whether you may have access to for an exemption and what documentation you may need to provide.

What happens if you do not meet the work requirement

If a work requirement is in effect in your state and you do not meet it and do not may have access to for an exemption, your Medicaid coverage will end. The timing of when coverage ends varies by state — some states give a grace period or notice period before coverage stops, while others stop coverage more quickly. Your state Medicaid office should notify you in writing before your coverage ends, usually with information about how to report work hours or request an exemption.

If your coverage ends because you did not meet a work requirement, you may be able to regain it by meeting the requirement in a future month or by may have access to for an exemption. You can also reapply for Medicaid at any time if your income or family situation changes. Contact your state Medicaid office to understand the process for regaining coverage in your state.

Frequently Asked Questions

Do I have to work if I am over 50?

Most states that have work requirements exempt people age 50 and older, but not all. Check your state's specific rules by contacting your state Medicaid office. If your state does exempt people over 50, you should not lose coverage due to a work requirement, but you may still need to report your income or recertify your may be able to access for other reasons.

What if I have a disability?

People with disabilities are typically exempt from work requirements in states that have them. However, you usually need to provide documentation of your disability. Contact your state Medicaid office to learn what proof they need and how to request a disability exemption.

Can I lose Medicaid if I do not meet the work requirement?

Yes, if a work requirement is in effect in your state, you do not meet it, and you do not may have access to for an exemption, your coverage will end. Your state must notify you before this happens and give you a chance to report work hours or request an exemption. If you lose coverage, you can regain it by meeting the requirement or by reapplying if your situation changes.

How do I report my work hours?

The method for reporting work hours varies by state. Some states use an online portal, others use a phone line, and some require you to mail in documentation. Your state Medicaid office will tell you how to report and what documentation you need to provide. Ask them for the specific process in your state.

What if my state's work requirement start date keeps getting delayed?

Delays happen because of court cases, administrative changes, or policy decisions. Contact your state Medicaid office to find out the current status. Do not assume a work requirement is in effect just because it was announced — confirm the actual start date with your state before your coverage renews.