States Impose Stricter Medicaid Work Requirements After Federal Rule Change

Millions of Americans applying for Medicaid in the coming years will need to prove they have been working, attending school, or volunteering for at least one month before qualifying for or retaining government health insurance. However, Republican lawmakers in several states argue that the new federal rules—part of the One Big Beautiful Bill Act, signed by President Donald Trump in July 2019—do not go far enough.

Indiana has taken the lead, enacting a law requiring applicants to demonstrate three consecutive months of work or similar activity to receive benefits. Other states have adopted the minimum federal requirement of one month, while some, like Idaho, have followed Indiana’s stricter approach. Idaho’s governor signed a three-month work requirement into law on April 10.

States including Arizona, Missouri, and Kentucky are also pushing for stricter implementation of the federal law. These efforts reflect a broader push to limit flexibility in how states apply the new rules.

“Normally, you would not see state legislators weighing in on these decisions,” said Lucy Dagneau, a senior official with the American Cancer Society’s advocacy arm.

The Congressional Budget Office estimates that 18.5 million adults will be subject to the new Medicaid work requirements, which will be enforced across 42 states and the District of Columbia. In Indiana, the rules will affect approximately 33% of the state’s Medicaid population.

Exemptions apply to children, individuals aged 65 or older, people with disabilities, and those with serious health conditions.

Typically, state administrators—not lawmakers—determine how to comply with new federal standards, often seeking guidance from federal regulators. However, the Centers for Medicare & Medicaid Services has yet to provide clear instructions on many aspects of the new law, prompting state lawmakers to take action.

Gov. Mike Braun, a Republican, signed Indiana’s three-month work requirement bill into law on March 4, making Indiana the first state to adopt the maximum allowed period under federal guidelines. State Sen. Chris Garten, a Republican, introduced the bill in January, arguing it was necessary to “align” state law with the new federal rules. Garten also framed the legislation as a measure to combat “waste, fraud, and abuse” in public programs.

During a January committee hearing, Garten stated that ineligible enrollees “rob the truly vulnerable Hoosier who actually needs the help.”

Democratic state Sen. Fady Qaddoura expressed skepticism, questioning the necessity of the bill. He asked Mitch Roob, Secretary of the Indiana Family and Social Services Administration, to provide an estimate of ineligible Medicaid enrollees in the state. Roob replied, “I think very few. It’ll never be none.” Qaddoura responded that there is no evidence supporting the legislation’s need.