On March 27th, the Kentucky Legislature voted to override Gov. Beshear’s (D) veto of House Bill 695, which requires the state to seek work requirements for able-bodied adult Medicaid recipients.
Kentucky has a divided government with a Republican-controlled legislature and a Democratic governor. Kentucky is one of six states that require a simple majority vote in each chamber of the legislature to override a veto.
The state Senate voted 29-7 and the House voted 80-20 to override the veto. The vote was along party lines in the Senate and along party lines in the House except for one Democrat, Rep. Matthew Lehman (D), joining Republicans in favor.
HB 695 requires state officials to submit a section 1115 waiver request to the federal Centers for Medicare and Medicaid Services (CMS). Section 1115 waivers allow states to institute experimental, pilot, or demonstration Medicaid plans, including plans with work requirements.
Gov. Beshear argued in his veto message the bill
- will result in loss of coverage for many people in Kentucky,
- will spark costly litigation and has an insufficient timeframe,
- violates the Contracts Clause of the Kentucky Constitution, and
- gives the legislature control of Kentucky’s Medicaid program, which is an executive branch program.
Proponents of the bill argued that it will improve Kentucky’s Medicaid program by allowing for better budgeting and increased efficiency. Sen. Amanda Mays Bledsoe (R) argued, “With these reforms, Kentucky is taking a proactive step to manage the integrity of it’s [sic] Medicaid program, ensuring accountability and transparency while maintaining essential services for those who rely on them.”
Kentucky’s program under HB 695, should CMS approve the waiver, will require able-bodied adults without dependents who have been enrolled in Medicaid for 12 or more months to complete minimum community engagement or work activities that qualify under federal code, including 20 hours weekly of one or a combination of
- working a job,
- participating in a work program, and
- participating in a workfare program.
HB 695 also contains other changes to the state’s Medicaid program.
On March 19th, Gov. Little (R) of Idaho signed a bill into law with a similar work requirements provision requiring the state to submit a waiver request to CMS. Upon approval, the state will institute work requirements for able-bodied adult Medicaid recipients.
The bill passed along party lines with a 29-6 vote in the Senate and 61-9 vote in the House. Idaho is a Republican trifecta, meaning that its governor and both chambers of its legislature are Republican-controlled.
Background
CMS approved Medicaid work requirement waivers in 13 states during the first Trump administration. Of these waivers, only Arkansas fully implemented its program before the Biden administration directed the agency to withdraw all approved waivers.
Georgia filed a lawsuit against CMS and HHS in January 2022 asking the United States District Court for the Southern District of Georgia to allow the state to proceed with Georgia Pathways as it was initially approved. The court ruled in favor of the state on August 19, 2022, and allowed the state to move forward with Georgia Pathways.
Georgia is currently the only state with Medicaid work requirements. Legislators and other officials in other states have expressed interest in pursuing section 1115 waivers for work requirements in 2025. These states include
- Arkansas,
- Ohio,
- South Carolina,
- Kentucky, and
- Idaho.
See also