New Federal Medical Work requirements mean less periods for the states

Catherine Hutton and Bram Silm Smith

When President Donald Trump signed a law adding work requirements to some of Medicaid beneficiaries, he may have legislators who are undermined at at least 14 states who were designing their own plans, according to health industry monitors.

Georgia is the only country that has the requirements for work in place, but many states have followed such a policy for years, just to be banned by the courts or, recently, the Biden administration. Some are looking for special state touches for the new rules. Others aim to implement work requirements before federal law applies at the end of 2026.

The movements of these states and the huge tax law in Trump shares one request: to keep the healthy medicaid coverage, adults who can work must prove that they are registering a lower number of hours in the job or school, or qualified to obtain one of the few exemptions.

But now, the states that jumped need to ensure their proposals, which require federal approval, away from the Trump law.

“The statute specifies both the floor and the ceiling” for the requirements of work, “said Sarah Rosnabjan, a professor of health policy at George Washington University.

South Dakota, for example, I announced in July that it will not provide Request for work requirements as previously planned to fears that Laxer’s rules are not allowed in the state under the new federal law. The Minister of Social Services of the Ministry of State has warned that working on the state’s proposal while federal rules “can be” can be “” it can be “”Feasibility exercise“

The Arkansas Plan, on the other hand, is more strict than federal law. There are no exemptions for her work requirements In the applicationIt is suspended with Medicare & Medicaid service centers.

Arizona’s proposal also includes something not in federal law: a ban on “capable adults” who receive Medicaid’s benefits for more than five years in their lives.

Government officials in Arkansas and Arizona said they are working with federal officials to raise their plans with new standards.

Andrew Nixon, the official spokesman for the US Department of Health and Humanitarian Services, said the administration analyzes how new federal standards interact with state exemptions.

The Federal Ministry of Health must issue rules by next June to determine how the states implement the requirements, according to what it said Elizabeth HintonWho was following such exemptions as part of the program on Medicaid and unlikely in KFF, which is a non -profit health information that includes KFF Health News.

“We don’t know exactly what it will cover,” Hinton said.

She added that it is unclear how Federal officials will respond to the requests of the states, but “we realize that some people believe that there is no room for maneuver here.”

The states can amend their Medicaid programs through what is known as illustrative concessions, which are subject to federal approval. The concessions are designed to test new ideas in political gray areas.

The states that have been submitted or plan to submit these requests with the requirements of work include Arizona, Arkansas, Georgia, Idahu, where Indiana, Iowa, Kentucky, Montana, New Hampsheer, North Carolina and Ouhayu, South Carolina, South Dakota, and Utta.

Republicans in Congress who passed the budget settlement bill left a field for states to use exemptions to track national standards. Tara Skar, a professor who leads the Law and Health Policy Program at Arizona University, said that she expects that states seeking to obtain some of the most striking requirements for approval, while more leniency may face denial.

Skarar said that federal officials may consider positively in the Arizona plan, as a five -year medicaid limit differs from work requirements. She added that the federal government illuminates strict work requirements, which calls for federal law, as these programs are likely to face legal challenges.

Federal law includes a minimum for 80 hours per month for work or education, with exemptions for some adults, including two medical -storey people and parents with young children and miserable children.

Montana is the first state to formulate a waiver request since Congress has completed the requirements of national action. The state lawmakers first agreed to work requirements – called “community participation” under the state plan – in 2019, but the state’s request was stopped during the end of the Trump’s first term and the Biden Administration.

After Trump again, legislators in Montana raised the expiration date of 2025 for the MEDICAID program, making the program always covered more than 76,000 adults in April, with the Trump administration expected to agree to work requirements. In mid -July, state officials They released their project To make this the truth “just as possible”.

Montana’s plan is largely in line with federal law, but it will create additional exemptions, including homeless people or fleeing domestic violence.

Republican Senator Gayel Lumires said that work requirements that also protect those people who need medicaid were a large part of persuading legislators to keep the expansion program. At that time, officials did not know where the federal government would obtain work requirements. Now, Lammers said, it makes sense for Montana to abide by her plan.

“The state must have an opinion,” Lomers said. “We are very independent, and everyone is different.”

At South Carolina, state officials are seeking to offer work requirements for a limited number of newly qualified Medicaid. South Carolina is one of 10 states that did not expand the family of Medicaid under reasonable prices, yet the state submitted a request with the federal government in June to expand partial Medicaid that includes the component of work requirements that greatly reflects new federal standards.

in message To the Minister of Health and Humanitarian Services, Robert F. Kennedy Junior, Governor of South Carolina Henry McMaster, a Republican, is called South Carolina’s proposal as a “state solution”.

The only country with an active work requirement program that now wants to expand its scope and wait for federal approval to do so. “Georgia Pathways to Coveraage” at the end of September is not over, unless CMS Greenlight, an extension of the program with a major change: demanding registrants to document once a year, not monthly. This is a focus away from the initial design of the program, but it is also different from the new federal rules, which call for checks every six months.

Fiona Roberts, a spokeswoman for Medicid in Georgia, said the state is still waiting to hear whether it needs to change its plan.

So Georgia is among the states that fold the forgetfulness, pending the guidance of the federal government.

KFF Health News Sam Whitehead and Lauren Sausser contributed to this report.

KFF Health News It is a national news room that produces in-depth press on health issues and is one of the basic operating programs in KFF-independent source of health policy research, polling, and journalism. Learn more about KFF.