Even if you wanted to, it would be difficult to miss the news about potential cuts to Medicaid, a healthcare program for low-income households and individuals. Whether or not Medicaid is cut, the following states have either implemented work requirements for Medicaid recipients or are in the process of doing so.
Arkansas: An early adopter of work requirements
In 2023, Arkansas requested federal approval to make Medicaid expansion conditional by requiring recipients to meet a work requirement.
Adults in Arkansas who are on Medicaid are enrolled in ACA Marketplace plans (or “Obamacare”). Any individual who doesn’t comply with workforce requirements would be moved from Marketplace coverage to fee-for-service coverage.
Georgia: A serious coverage gap
Georgia opted not to expand Medicaid when Obamacare was enacted in 2010. Had it expanded Medicaid coverage, residents with an income up to 138% of the federal poverty level would have access to Medicaid.
Instead, the state made the program available to households earning less. For example, a family of three could not earn more than $25,820 annually, and an individual could not make more than $15,060. In addition, Georgia added a work requirement condition. As a result, an estimated 175,000 adults in Georgia are stuck in a coverage gap. These individuals have incomes below the poverty level but do not qualify for Medicaid in the state.
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Mississippi: It’s anyone’s guess
While hopes for Medicaid expansion died in Mississippi last year, two of the most influential lawmakers in the state’s Senate, Lt. Gov. Delbert Hosemann and Senate Medicaid Chair Kevin Blackwell, told Mississippi Today that they will not consider any expansion plan that fails to include a work requirement.
North Carolina: Expanded coverage with a hoped-for twist
Although North Carolina adopted the ACA Medicaid expansion in March 2023, legislators included a provision to include a work requirement element. If implemented, the requirement is expected to result in a substantial loss of participants.
Ohio: Giving it another shot
The Ohio General Assembly included a measure in the most recent state budget requiring Medicaid recipients to work. Under the proposed change, Ohioans must work at least 80 hours per month to receive Medicaid.
South Dakota: Taking it back to the voters
Thanks to a 2022 ballot initiative, the state finally adopted Medicaid expansion in mid-2023. When it was first approved in 2022, the measure prohibited the state from imposing additional burdens or restrictions on eligibility. However, in early 2024, the state legislature passed a resolution adding another ballot measure asking voters to approve work requirements for Medicaid recipients. The measure passed with 56% of voters in favor. The state must seek the approval of the Centers for Medicare & Medicaid Services (CMS) to implement new work requirements.
The reality of work requirements
If members of Congress believe they will save billions of dollars by cutting Medicaid or making it more difficult for recipients to receive assistance, they may be disappointed. According to the health policy research, polling, and news organization KFF, a 2023 study showed that most Medicaid recipients under age 65 worked. Among those under 65 with Medicaid who did not receive benefits from the Social Security disability program, 64% worked (44% full time and 20% part time). Caregiving responsibilities, illness, disability, or school attendance help explain those not working outside the home.
In the meantime, if you count on Medicaid to cover your medical expenses, it’s important to remember that most of what we’re hearing is just talk. Any changes to Medicaid may be difficult to justify. A 2025 KFF Health Tracking Poll found that about three-quarters of the American public have a favorable view of the program, and that number doesn’t look as though it will change anytime soon.
