What You Need to Know About Work Requirements

Medicaid is a safety net that covers nearly one in five Americans, including children, people with disabilities and nearly two million veterans. Recently, some states have decided to implement work or community engagement requirements for their Medicaid programs. Here are some key things to know about Medicaid work requirements.

States wishing to implement work requirement programs apply to the Centers for Medicare and Medicaid Services (CMS) for a Section 1115 Medicaid waiver. CMS issued policy guidance in January 2018 outlining the populations who can be included in work requirements and how states can design their programs.[1]

Programs vary by state, but typically require nondisabled, working age adults to participate in 80-100 hours per month of work, education, job training, or community engagement – which may include volunteering, caregiving or other similar activities.[2]

Beneficiaries typically track and report their work and community engagement hours to a state agency. Online reporting systems allow users to report exemptions (e.g., pregnancy), and work or volunteer activities and hours with a particular organization.[3]

Certain individuals are typically exempt from work requirements, such as children and seniors, pregnant women, caregivers, some people with disabilities, and people experiencing homelessness. Exemptions can vary by state and must be regularly reported.[4]

Three states have implemented work requirements: Arkansas, Indiana, and New Hampshire.

Another four states have work requirements waivers approved by CMS but have not yet implemented the program; including Arizona, Kentucky, Ohio, and Wisconsin.[5]

Seven states have waiver applications pending with CMS, including Alabama, Mississippi, Oklahoma, South Dakota, Tennessee, Utah, and Virginia.[6]

Policymakers and advocates are collaborating to address how work requirements impact coverage for more than 70 million Americans through the Medicaid program. The Modern Medicaid Alliance educates the public about the value of Medicaid and the populations it serves. To learn more about Medicaid and watch testimonials of how the program has helped real people, visit ModernMedicaid.org.


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[1] https://www.medicaid.gov/medicaid/section-1115-demo/community-engagement/index.html

[2] https://khn.org/news/5-things-to-know-about-medicaid-work-requirements/

[3] https://www.kff.org/report-section/an-early-look-at-implementation-of-medicaid-work-requirements-in-arkansas-key-findings-9243/

[4] https://www.healthaffairs.org/do/10.1377/hblog20180812.221535/full/

[5] https://nashp.org/state-proposals-for-medicaid-work-and-community-engagement-requirements/

[6] https://nashp.org/state-proposals-for-medicaid-work-and-community-engagement-requirements/