Donald Trump (R) was inaugurated as president for his second term on January 20, 2025. During his first term, the Centers for Medicare and Medicaid Services (CMS) invited states to apply for Section 1115 waivers, which, if approved by CMS, allow states to implement work requirements and other conditions for Medicaid.
Between 2018 and 2020, CMS approved Section 1115 waivers for 13 states that imposed work and reporting requirements on Medicaid recipients. These states were:
- Arizona
- Arkansas
- Georgia
- Indiana
- Kentucky
- Maine
- Michigan
- Nebraska
- New Hampshire
- Ohio
- South Carolina
- Utah
- Wisconsin
Nine other states submitted Section 1115 waivers but did not receive CMS approval before the Biden administration began withdrawing waivers in 2021:
- Alabama
- Idaho
- Kansas
- Mississippi
- Montana
- Oklahoma
- South Dakota
- Tennessee
- Virginia
Due to litigation, state withdrawals, and the Covid-19 pandemic, only Arkansas successfully implemented work requirements during the Trump administration.
Following the election of President Joe Biden (D) in 2020, CMS withdrew all of these approved waivers, including that of Arkansas. In response, many of the affected states filed lawsuits, asserting that their Medicaid work requirements were legally justified. Only Georgia succeeded in its legal challenge. On August 19, 2022, the U.S. District Court for the Southern District of Georgia ruled in favor of the state, allowing Georgia to proceed with its Medicaid work requirement program, known as Georgia Pathways.
Additionally, Idaho, Mississippi, Oklahoma, South Dakota and Tennessee have pending Section 1115 waivers that include Medicaid work requirements.
South Dakota voters recently approved Amendment F, a constitutional amendment that would allow the state to implement Medicaid work requirements. However, the amendment is contingent on approval from the federal government, which would need to grant a Section 1115 waiver for the program to be put into effect.
North Carolina passed legislation in 2023 to expand Medicaid, with a provision to seek approval for work requirements if CMS is likely to approve them.
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