As work requirements kick in for Medicaid, some states are taking a tougher stance
In January, a new set of work requirements for Medicaid beneficiaries will begin across the United States, stemming from President Donald Trump's 2025 tax cut and policy law. Six Republican-led states are imposing even stricter rules than mandated by the law. The federal government claims that self-attestation, or beneficiaries declaring they are too medically frail to work, will help avoid fraud, but critics argue this approach is flawed.
Arkansas, Idaho, Indiana, New Hampshire, North Carolina, and Ohio have laws or policies that ban self-attestation for work requirements starting next year. Missouri lawmakers passed a constitutional amendment requiring documentary evidence of work or exemptions, but it failed to gain Senate approval. The Medicaid expansion affects up to 20 million adults in 40 states and the District of Columbia, requiring them to work or volunteer 80 hours monthly or attend school half-time to maintain benefits.
The law requires twice-yearly reevaluations for most recipients, with self-attestation only allowed during initial enrollment until 2028.
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