States begin implementing Medicaid work requirement

What This is

• New federal rules require many Medicaid enrollees to show about 80 hours a month of work, school, job training, or volunteering to keep coverage, along with more frequent paperwork checks.
• Nebraska is the first state to start dropping people for noncompliance, and the state estimates about 200 residents will lose Medicaid coverage on Aug. 1.
• Other states, including Montana, have begun implementing the rules and plan to remove enrollees who do not document that they meet the requirement.
• The federal exemption list does not automatically exempt people experiencing homelessness, raising concerns that some could lose coverage and face added barriers to care.
• Rare disease and chronic illness advocates warn that paperwork burdens and uneven state implementation could cause patients and caregivers to lose coverage even when they should be exempt.
• A federal judge rejected a request from 26 states to pause the work requirements, keeping the rollout on track while the lawsuit continues.

Why This Matters

• Tying health coverage to monthly reporting can push people off Medicaid for paperwork mistakes, even if they still qualify.
• Because states control how they check hours and grant exemptions, access to care may vary sharply by state and by a person’s ability to navigate forms and deadlines.
• Disputes over exemptions, like what counts as “medically frail,” shape whether sick people and caregivers must repeatedly prove they cannot work.
• Coverage losses can shift costs to hospitals, clinics, and local governments through more unpaid care and untreated illness.