There’s been a lot of talk lately about Medicaid work requirements in the so-called “One Big Beautiful Bill Act.” But what many people don’t realize is that these changes aren’t just coming in 2026—they’re already being pushed forward in several states. Some states have submitted proposals that could speed things up, introduce stricter limits, or make exemptions harder to get.
Here’s what you need to know.
When Do Medicaid Work Requirements Start?
The bill says states must begin implementing work requirements no later than December 31, 2026. But that doesn’t mean they have to wait until then—some states are already asking for permission to start earlier.
Federal Work Requirement Rules
Under the new federal rules, Medicaid recipients may need to:
- Work, volunteer, attend school or participate in a job training program for at least 80 hours per month, or
- Earn income equal to 80 hours of work at minimum wage
There are also federal exemptions. You won’t need to meet work requirements if you are:
- Under age 19
- On Medicare
- Recently released from prison
- A parent, guardian, or caretaker of a child under 13 or someone with a disability
- A veteran with 100% disability
- Medically frail
- Pregnant or postpartum (some states extend this to 12 months postpartum)
- In substance use treatment
But remember, there is some flexibility in what each state can choose to do within these rules.
States Pushing for Work Requirements Now
States can add their own rules and exemptions, but they must request permission through a Section 1115 waiver.
Which States Are Taking Action Now?
These states have already submitted waiver requests:
Arizona is proposing 20 hours per week for adults ages 19–55. Wants to impose a five-year lifetime limit on Medicaid coverage. Proposes cost-sharing for non-emergency ER visits. Exempts a wide range of people including caregivers, domestic violence survivors, and the homeless.
Arkansas rules would apply to adults ages 19–64, excluding those on Medicare or who are medically frail. Caregiving for a child, senior, or disabled person can count toward the requirement.
Georgia requires 80 hours per month of work, education, or community service through its Pathways to Coverage program. This program began in 2023 and is currently seeking a 5-year extension.
Iowa is proposing 100 hours per month of work, wages, or job training. Exempts those receiving SNAP or TANF, among others.
Ohio is asking for work requirement that would apply if you are under age 55 and not otherwise exempt. Criteria include being employed, in school or training, or receiving treatment for substance use.
South Carolina has introduced a waiver that targets “parent caretaker relatives” ages 19–64. Requires 80 hours of work or education per month. SNAP, TANF, or unemployment compliance counts toward the requirement.
Utah rules apply only to adults covered through Medicaid expansion. Requires participants to apply to 48 jobs and complete training every year. Exemptions include people over 60, pregnant/postpartum women, and primary caregivers.
South Dakota requires SNAP recipients to participate in employment, education, or caregiving. It includes exemptions for people in areas of high unemployment.
States Pursuing Changes Through Legislation
Some states are working on state laws that would implement work requirements.
Idaho wants to require 20 hours/week for adults 19–64, with typical exemptions.
Indiana wants to require 20 hours/week of work or volunteering.
Montana would like to require 80 hours/month for adults 19–62, with a long list of exemptions.
What This Means for You
Even if you’re not in one of the listed states, this matters. If a state receives approval for stricter requirements or lifetime limits, others are likely to follow.
And don’t forget—every Medicaid recipient will soon need to recertify every six months, starting January 1, 2026. That’s a major change from the usual annual process, and it will increase the risk of delays and disruptions. Be proactive with paperwork and documentation to avoid losing coverage.
Relief Recap
These new Medicaid work requirements are rolling out quickly—and the rules can vary dramatically depending on where you live. Some states are pushing to start early, others are adding lifetime limits, and everyone will soon have to recertify every six months starting in 2026.
