The 2025 Federal Budget Reconciliation Law includes provisions allowing Medicaid work requirements, which remain under discussion among policymakers and researchers. Researchers at the organization have published several resources on the subject, including “A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law” and “5 Key Facts About Medicaid Work Requirements”.
These resources provide an overview of the work requirement provisions and their potential impact on Medicaid enrollees. Exceptions may apply for individuals with disabilities, caregivers, and those who are medically frail, though specific rules vary by state and federal guidance.
Implementation of Work Requirements
Some states, including North Carolina and California, are among those exploring or planning to implement Medicaid work requirements under federal waivers. States implementing work requirements may face challenges such as budget shortfalls and the need to develop tracking systems, though specifics vary.
A 50-state survey found that some states were still in early stages of planning for Medicaid work requirements as of 2026. States may consider additional exceptions for groups like those with mental health or substance use disorders, depending on federal approval.
Research and Analysis
Researchers have been studying the impact of Medicaid work requirements on enrollees and the healthcare system as a whole. A literature review published in 2018 found that there is a complex relationship between work and health, and that work requirements may not be effective in improving health outcomes for all individuals.
For example, a 2025 report found that most adults subject to Medicaid work requirements are already working or face barriers to work, such as lack of transportation or childcare.
State Experience and Implications
Arkansas implemented Medicaid work requirements under a waiver, with reported challenges in compliance and enrollment. A 2019 report found that disability and technical issues were key barriers to meeting the work and reporting requirements in Arkansas.
Other states are considering alternative approaches to supporting work without requiring it, such as state and managed care initiatives. These initiatives may include providing job training and placement services, as well as supporting enrollees in finding and maintaining employment.
The organization will likely continue to play a key role in providing research and analysis on this topic, and in informing policymakers and stakeholders about the potential implications of work requirements.
In addition to the research, the organization has also provided guidance to states on how to implement work requirements in a way that is fair and effective. They have emphasized the importance of providing support to enrollees who may struggle to meet the work requirements, such as those with disabilities or caregiving responsibilities.
