Policy Trend: Medicaid Work Requirements

As states and the federal government look for ways to cut spending, an obvious place to look is one of the largest budget items for all jurisdictions: Medicaid. While actual cuts to services and population are not popular, the addition of work requirements for recipients has been a perennial (though so far unsuccessful), option for budget conscious legislators.

So far in 2025,12 bills in 7 states have been introduced that would require some community engagement in order to receive Medicaid benefits (Mississippi’s bill HB 1597 died in committee). Of note, legislation in Missouri (SJR 43) would enact a constitutional amendment requiring work or community engagement of Medicaid recipients, and Idaho HB 138 would end the voter-approved Medicaid expansion if work requirements are not adopted. Though there is still some time left in most legislative sessions, only Idaho and New Hampshire (SB 134) have held hearings and reported legislation favorably out of committee thus far.

Additionally, the federal money associated with Medicaid may come with new strings. Speaker Johnson has indicated that adding a work requirement is on the table as budget negotiators are looking for billions in savings. Because the federal government matches anywhere from $.50 to $.90 per state dollar spent on Medicaid, it’s a sizable chunk of funding that states get for these programs. If the federal government decided to eliminate or curtail those dollars if work requirements were not implemented, it would have very serious consequences for state budgets.

Track Health Care Policy

The ever-evolving state health policy landscape will continue to influence how health care organizations make business decisions. MultiState’s team pulls from decades of expertise to help you effectively navigate and engage. MultiState’s team understands the issues, knows the key players and organizations, and we harness that expertise to help our clients effectively navigate and engage on their policy priorities. We offer customized strategic solutions to help you develop and execute a proactive multistate agenda focused on your company’s goals. Learn more about our Health Care Policy Practice.