Map Shows States With Medicaid Work Requirements as Change Possible

By Claire Dickey / February 19, 2025

In a renewed push under the Trump administration, states across the U.S. are revisiting the controversial topic of Medicaid work requirements.

Georgia is the only state actively enforcing these requirements. Arkansas is making a significant push to reintroduce work requirements alongside several other states that are also considering the implementation of similar policies.

Why It Matters

Medicaid work requirements are a hotly debated issue. Proponents argue they encourage personal responsibility and reduce government spending, while critics claim they restrict access to necessary healthcare and complicate the lives of low-income individuals—potentially increasing the uninsured rate.

What To Know

Medicaid work requirements mandate certain enrollees to engage in activities such as working, volunteering or educational programs to qualify for health coverage.

s of early 2025, Georgia remains the only state with an active work requirement program, but several others, including Arkansas and Ohio, are moving to reintroduce or modify existing policies.

These requirements generally apply to able-bodied adults, with exemptions typically provided for individuals who are elderly, disabled, pregnant or caring for young children.

The implementation of these requirements has been met with mixed reactions and results. For example, Georgia has seen low enrollment numbers and high administrative costs.

"[Georgia's] program was plagued by terrible enrollment—with only 4500 people enrolling in the first year, compared to the 30,000-100,000 the state predicted (and the nearly 450,000 who would have been eligible if the state had done a regular Medicaid expansion," Ben Sommers, Harvard professor and former health official in the Biden and Obama administrations, told Newsweek.

Sommers added that Georgia incurred over $20 million in administrative expenses simply to establish the program.

While Arkansas introduced work requirements in 2018, the state removed them the following year after a federal judge ruled they created numerous obstacles for Medicaid recipients without significantly improving employment. According to KFF, over 18,000 Arkansans lost coverage due to these policies in 2018.

"95 percent of people in the [Arkansas] program were already working or meeting another qualifying activity or exemption (like child care, schooling or having a disability)—so there really wasn't much room to move the needle on employment," said Sommers.

In Janurary, the state made a move to once again implement work requirements under Governor Sarah Huckabee Sanders.

The Congressional Budget Office (CBO) has highlighted that while such policies are likely to reduce federal spending, they do not increase employment and lead to a higher number of uninsured individuals. Further, states bear high administrative costs to implement these requirements, with varying estimates ranging from under $10 million to more than $270 million, per the U.S. Government Accountability Office (GAO)—primarily funded through federal sources.

For enrollees, the complexity of these programs can lead to confusion, particularly for those with inconsistent employment—such as gig workers or part-time employees—who may struggle to meet the hourly thresholds.

What People Are Saying

Ben Sommers, Harvard professor and former health official in the Biden and Obama administrations, told Newsweek: "... The evidence indicates that work requirements have not succeeded in boosting employment, and instead they just create red tape and take health coverage from people. If the goal is to help Medicaid beneficiaries improve their financial circumstances, the policy has failed.

If the goal is to kick people out of the program to save money for tax cuts, then Congress may not care that it won't boost employment and will hurt people's health care access. But the experience in these other states indicates it's been a failed policy and will cause a lot of harm."

Dr. Megan B. Cole, co-director of Boston University Medicaid Policy Lab, previously told Newsweek: "While the theoretical idea is that Medicaid work requirements would incentivize individuals to work, this is very misguided—nearly all able bodied persons enrolled in Medicaid currently work. Those who do not work are either disabled or having care taking responsibilities."

"Rather, the Medicaid work requirement would merely serve as an administrative barrier to remaining enrolled in Medicaid, as it involves onerous administrative reporting requirements, where a small mistake in reporting your worked hours or a misinterpretation of the reporting instructions may drop you from insurance coverage entirely."

House Majority Leader Steve Scalise, a Lousiana Republican, told CNBC last week: "Well, we're looking at different things. Obviously, work requirements in Medicaid is the place you would start.... Even going back to COVID, Medicaid mushroomed exponentially, adding millions more people onto the program that were not on it before. That had private insurance, other forms of insurance. And now the taxpayers of America are picking up that tab."

Arkansas Governor Sarah Huckabee Sanders said in a January 28 press release: "Today, I am submitting a waiver on behalf of the State of Arkansas to allow us to implement a work requirement for all able-bodied, working-age recipients of Arkansas' Medicaid expansion program, ARHOME. Under the prior Trump Administration, Arkansas was successfully implementing a work requirement before federal litigation halted our progress. This new waiver reduces administrative hurdles and other issues for legitimate Medicaid expansion recipients while still achieving our policy goal: to have Medicaid serve as a safety net rather than a poverty trap."

Senator John Kennedy, a Lousiana Republican, wrote on X (formerly Twitter) last week: "There's a moral principle to Medicaid work requirements: If you can work, you should work."

What Happens Next

The debate over Medicaid work requirements is likely to heat up as more states submit proposals for federal approval.

With the Biden administration previously revoking many of these policies—and the Trump administration now encouraging them—the issue remains a significant battleground in the broader conversation about welfare and healthcare in the U.S.