States Rush To Figure Out How To Enforce Trump’s Medicaid Work Requirements
State officials are uncertain about enforcing Medicaid work requirements, with some using artificial intelligence to automate compliance verification, as the Jan. 1, 2027 deadline nears. The Congressional Budget Office estimates that work requirements will reduce federal Medicaid spending by $326 billion over 10 years.
State officials are struggling to implement Medicaid work requirements, with some launching programs this week. A KFF survey of 42 states and the District of Columbia reveals varying approaches, including using artificial intelligence to verify compliance. The requirement, part of the One Big Beautiful Bill Act, mandates that Medicaid enrollees work or participate in qualifying activities for at least 80 hours monthly. The Congressional Budget Office estimates that this will reduce federal Medicaid spending by $326 billion over 10 years and leave 4.8 million more people uninsured by 2034. States are defining 'medical frailty' exemptions, with 21 states having no definition as of March. Nebraska is implementing its work requirement on May 1.
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