As work requirements kick in for Medicaid, some states are taking a tougher stance

At least six states will require documentation that individuals are too sick to meet Medicaid work requirements kicking in next year Work requirements for some Medicaid beneficiaries begin across the U.S. in January, the result of President Donald Trump’s big 2025 tax cut and policy law, and a handful of Republican-led states are imposing tougher rules than the law requires.

At issue is how someone can prove they are too medically frail to work. While federal regulations say the state can take the recipient’s word for it for the first year, at least six states are requiring documentation immediately. There is a continuing push in other states to follow suit eventually.

Advocates say that could create problems, especially for new applicants to the joint state-federal health insurance program for lower-income people. “Someone may not be able to work, but they can’t see a doctor because they can’t afford it. So they’re now applying for Medicaid,” said Jennifer Tolbert, director of state health policy and data at the research organization KFF.

“But Medicaid is saying you need documentation from a provider.” As some Republican-led states take a tougher-than-required approach to implementing the federally mandated changes, Democrats in 25 states are suing and asserting that the rules are too harsh. Some say documentary evidence is necessary to avoid fraud The Medicaid changes are projected to save the federal government $887 billion over the next decade and result in 7.5 million fewer people with health insurance, according to the Congressional Budget Office’s 2025 estimate. The conservative Foundation for Government Accountability has been pushing states not to make it too easy for people to avoid work requirements, saying able-bodied adults are pushing enrollment and costs higher.

Jonathan Ingram, vice president of research and policy at the group, has been encouraging states not to take a beneficiary’s word for it, a process known as self-attestation. “Self-attestation is fraud-by-design,” he said via email. “It is a policy developed by bureaucrats to maximize enrollment at the expense of program integrity.” Self-attestation comes under penalty of perjury, so people who lie can be subject to criminal charges — though such charges are rare.

Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio all have laws or policies that bar self-attestation to qualify for the work requirement exception starting next year. Darin Chappell said he worked with the Fo… There is a continuing push in other states to follow suit eventually.Advocates say that could create problems, especially for new applicants to the joint state-federal health insurance program for lower-income people.“Someone may not be able to work, but they can’t see a doctor because they can’t afford it.