Medicaid Work Requirements

Update: July 14, 2020

Today, the Trump Administration filed a petition asking the U.S. Supreme Court to reverse rulings that struck down work requirements for Medicaid recipients sought by Arkansas and New Hampshire. This action follows the February 2020 decision by the U.S. Court of Appeals for the D.C. Circuit to unanimously uphold the decision reached by a federal district court in 2019 overturning HHS’ approval of Arkansas’ Medicaid waiver.

The Court of Appeals found that approval of the waiver violated the Administrative Procedure Act because HHS did not consider how the waiver would further “the principal objective of Medicaid,” providing access to healthcare. The court also importantly noted that while the objectives of Medicaid do include promoting independence, that refers to the provision of “rehabilitative and other services, not financial independence from government welfare programs,” which is the primary objective of work requirements.

In the petition to the Supreme Court, the Trump Administration argues that the court of appeals wrongly decided the case and that the ruling “casts a shadow” on multiple other states’ approved or pending work requirement waivers and “threatens to impede innovations” that may make state Medicaid programs more “sustainable.” The Arkansas Attorney General also filed a request for the Supreme Court to review the case.

Responses by the attorneys for the plaintiffs are due in mid-August. We will continue to monitor this litigation and other efforts to implement work requirements around the country.


On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) released new guidelines in a State Medicaid Director Letter that for the first time allows states to require people to work to receive Medicaid. Since issuing the guidance, CMS has approved work requirement waivers in a number of states, and additional states have requests to add work requirements pending at CMS (see details on all approved and pending waivers here). 

In general, federal Medicaid law prohibits work requirements.  However, states can waive parts of the law if they offer something different that still promotes the goals of Medicaid, such as expanding eligibility or increasing reimbursement rates.  Previous Administrations denied work requirements, saying they do not further the goals of Medicaid. And recently, federal courts have struck down HHS’ approvals of Medicaid work requirements in several states (Arkansas, Kentucky, Michigan, and New Hampshire).

When work requirements go into place, anyone who is not working or participating in training for future employment a certain number of hours loses their Medicaid coverage. Even people who are working may lose their Medicaid if they fail to meet the onerous requirements of submitting evidence proving they are working. States typically include some exemptions from work requirements, including for some people with disabilities. However, how states define people with disabilities is so strict that many people who cannot work because of a disability are still subject to work requirements. And even people who are exempt may struggle to complete the complicated administrative process required to qualify for an exemption.

A study in Arkansas, the first state to implement a Medicaid work requirement (before a court struck it down), revealed the damage that Medicaid work requirements can cause. During the first six months of Arkansas’ policy, thousands of people lost coverage due to the work requirement even though more than 95% of the people targeted by the policy appeared to meet the requirements or qualify for an exemption. Furthermore, the policy did not appear to result in any significant changes in employment. 

For the first time, the federal government is allowing states to require people to work to access healthcare through Medicaid. Federal courts have struck down the government’s approvals of work requirements in several states for conflicting with Medicaid’s purpose – to provide health coverage to people who cannot otherwise afford it. However, litigation on Medicaid work requirements is ongoing, as the Trump Administration recently filed a petition asking the U.S. Supreme Court to reverse lower court rulings striking down work requirements in Arkansas and New Hampshire. Work requirements could have devastating consequences for people with disabilities, causing many people to lose their Medicaid.

The federal government has said work requirements only apply to people who are “able-bodied.”   Even though some people with disabilities (like people who meet the strict criteria for “disabled” for purposes of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)) may be exempted, many other people with disabilities or chronic conditions who do not meet these strict standards will be subject to these policies. Therefore, millions of people on Medicaid who have disabilities or “pre-existing conditions” could still be subject to work requirements.  In addition, caregivers of people with disabilities could also be forced to choose between providing care to their family member or lose their own access to Medicaid.

Our biggest concerns:

Losing Medicaid Coverage

  • Thousands of people will lose Medicaid coverage in each state that implements work requirements.
  • Many people with disabilities do not have the medical documentation they need to show that the meet the exemption from a work requirement.
    • The standards for these documents are very high, often requiring assessments and special services that most people cannot afford, even with their insurance.
    • People will have to resubmit these documents often, so the process itself will be a burden for many people with disabilities
  • States punish people who cannot find work by taking away their health insurance, making it harder for them to stay healthy and less able to find and maintain work.

Barriers to Accessing Medicaid

  • Many people who have relied on Medicaid for years will not know they have to submit this paperwork and could face losing their insurance or gaps and delays in their coverage.
  • Other barriers to accessing health care and employment prevent people with or without disabilities from getting these documents (like discrimination, access to transportation, or access to a doctor), so they will lose insurance for factors beyond their control.
  • These policies also hurt family caregivers, who are “exempt” from the work requirements, but have to meet strict criteria and go through a long process to prove it.

Administrative Burden Makes it Even Worse

  • States that implement work requirements will have to create a new process to screen applicants for Medicaid which will take funding away from health care services for those receiving Medicaid.
  • People who are injured or disabled may need to wait months without health insurance before their documents are processed.
  • State errors in work requirement programs are incredibly common, and people with disabilities and caretakers are more likely to lose coverage during periods of leave or unemployment when they should be exempt.

What does this mean for your state?

CMS has already approved Medicaid waivers with work requirements in a number of states, and additional states have requests pending to add work requirements to their Medicaid programs. However, federal courts have struck down CMS’ approvals of Medicaid work requirements in several states (Arkansas, Kentucky, Michigan, and New Hampshire).

For information about your state see: 

What Can You Do?

  • Call your Governor’s office and let them know that you oppose Medicaid work requirements.
    • Governors decide to submit the work requirement waivers. If you live in one of the states where these waivers have been submitted or approved, call your Governor to tell them how disappointed you are.
    • If you live in a state that has not yet requested this waiver, urge your Governor to issue a statement explicitly saying that they will not pursue Medicaid work requirements.
  • Call your Members of Congress and urge them to oppose Medicaid work requirements.
    • If your member of Congress already has opposed them, thank them for their support and ask them to remain vocal in their opposition.
  • CMS is required to hold a public comment period for each waiver that is requested. Make your voice heard and submit your comment today!
Resources on Medicaid Work Requirements
How Medicaid Work Requirements Will Harm People With Disabilities and Serious Illnesses, Center on Budget and Policy Priorities 1/26/18

Medicaid Waiver Tracker, Kaiser Family Foundation

Medicaid Work Requirements – Results from the First Year in Arkansas, New England Journal of Medicine 9/12/19

Letter from Sen. Wyden and Rep. Pallone Opposing Approval of Harmful Medicaid Waivers Including Work Requirements 2/19/19

Health Care Providers, Advocates Explain Harm of Medicaid Work Requirements, Center on Budget and Policy Priorities 2/21/19

Proposals to Couple Medicaid Expansion With Work Requirements: FAQs, Center on Budget and Policy Priorities 4/10/19

Medicaid Work Requirements Can’t Be Fixed, Center on Budget and Policy Priorities 1/10/19

Medicaid Work Requirements Don’t Protect People With Disabilities, Center on Budget and Policy Priorities 11/14/18

How Might Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waiver Programs?, Kaiser Family Foundation 1/26/18

Medicaid Work Requirements Will Have Devastating Impacts for People with Complex Health Needs, Community Catalyst 02/12/18

Eligibility Restrictions in Recent Medicaid Waivers Would Cause Many Thousands of People to Become Uninsured, Center on Budget and Policy Priorities 8/9/18

Many Working People Could Lose Health Coverage Due to Medicaid Work Requirements, Center on Budget and Policy Priorities 4/11/18

Medicaid and Work Requirements: New Guidance, State Waiver Details and Key Issues, Kaiser Family Foundation  1/16/18

Work Requirements Don’t Work, Center on Budget and Policy Priorities 1/10/18

Trump’s Medicaid Work Requirements Could Put At Least 6.3 Million Americans at Risk of Losing Health Care, Center for American Progress 01/12/18

HHS Approves Harmful Section 1115 Waiver in Kentucky: Effects on People with Disabilities, NHeLP 1/12/18

What Medicaid’s Work Requirement Means For Seniors, People With Disabilities, And Their Caregivers, Forbes 01/19/18

Medicaid ‘work requirements’ won’t improve health outcomes, The Hill 01/18/18

Medicaid Work Requirements Will Reduce Low-Income Families’ Access to Care and Worsen Health Outcomes, Center on Budget and Policy Priorities 2/8/18

Alabama’s Proposal Will Cost Thousands Their Medicaid Coverage, Won’t Encourage Work, Center on Budget and Policy Priorities 3/8/18

Understanding the Intersection of Medicaid and Work: What Does the Data Say? Requirement, Kaiser Family Foundation 8/8/19

How Medicaid Work Requirements Harm People with Mental Health Conditions,Center on Budget and Policy Priorities 3/7/18

New Trump rules will drive people with disabilities off Medicaid and out of work, USA Today 3/7/2018

Medicaid Work Requirements Proposal Advances in the Legislature, Star Tribune 3/29/2018

Working People Could Still Lose Coverage Under Medicaid Work Requirements, Vox 4/11/2018


ASAN Statement on Medicaid Work Requirements (01/11/18)

CCD Statement on Medicaid Work Requirements (02/07/18)

CPSD & APSE Statement (02/08/18) 

Work requirements are being imposed on other programs that are important to people with disabilities and their families.  To learn more, visit Work Requirements Beyond Medicaid.

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