US states tighten proof rules as Medicaid work requirements approach
At least six Republican-led US states plan to require immediate documentation from Medicaid beneficiaries who claim medical reasons for exemption from new work requirements. Advocates warn the policy could prevent eligible people from securing coverage, while supporters say stronger verification is needed to protect program integrity.
At least six US states are requiring Medicaid beneficiaries to provide documentation immediately if they claim a medical condition prevents them from meeting new work requirements that begin next year. The changes follow President Donald Trump’s 2025 tax cut and policy law, which introduces work requirements for some adults enrolled through Medicaid expansion. Federal rules allow states to accept a beneficiary’s statement during the first year, but Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio have adopted policies barring that approach.
Beneficiaries covered by the mandate will generally need to work or volunteer for at least 80 hours a month, or attend school at least half-time. Exceptions include medical frailty, although a Centers for Medicare and Medicaid Services rule says a condition must significantly impair a person’s ability to work, volunteer or attend school. Jennifer Tolbert of research organisation KFF said the documentation requirement could create problems for people who cannot work but cannot afford to see a doctor.
Such people may apply for Medicaid precisely because they lack access to medical care, she said. The conservative Foundation for Government Accountability supports stricter verification. Its vice-president of research and policy, Jonathan Ingram, said accepting self-attestation undermined program integrity.
Self-attestation is made under penalty of perjury, although criminal charges for false statements are rare. Democrats in 25 states are suing, arguing that the rules are too harsh. The Congressional Budget Office’s 2025 estimate projected that the Medicaid changes would save the federal government $887 billion over a decade while leaving 7.5 million fewer people insured.
The mandate could affect up to 20 million lower-income adults without children at home in the 40 states and District of Columbia that expanded Medicaid. Most enrollees will also face eligibility checks twice a year rather than once.
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