On April 14, 2026, the Kentucky General Assembly voted along party lines to override line item vetoes from Kentucky Gov. Andy Beshear (D) of House Bill 2 and enshrined changes to Medicaid rules into state law. Beshear had vetoed several portions of the bill, including a requirement that Medicaid applicants demonstrate three months of compliance with newly created work requirements before they are eligible for benefits. All 80 Republicans in the House and all 32 in the Senate voted to override the vetoes. No Democrat in either chamber did.

Kentucky is one of four states with a veto-proof state legislature and an opposing party governor. The other states are Kansas, North Carolina, and Vermont. This means that in these states, one party controls enough House and Senate seats to overturn a gubernatorial veto without any support from the other party. Kentucky has a Democratic governor and a Republican-controlled legislature.

Background

The 2025 One Big Beautiful Bill Act requires states to adopt community engagement requirements for able-bodied adults ages 19-64 without dependents in the ACA Medicaid expansion group by January 1, 2027. These community engagement requirements can be met by doing any of the following for 80 hours a month:

• working,
• doing community service,
• participating in a work program, or
• doing a combination of these activities.

An individual could also meet the requirements by enrolling at least part-time in an educational program or by making a monthly income of at least 80 times the federal hourly minimum wage. Failure to comply with the community engagement requirement would result in the denial of an application for Medicaid or disenrollment from the program.

Before the enactment of the OBBBA, there were no federally mandated work requirements for Medicaid. States could implement such policies by applying for a Section 1115 waiver. During the first Trump administration, 13 states received approval to implement work requirements using these waivers, but most efforts were blocked by legal challenges. The Biden administration later withdrew all 13 waivers. Georgia was the only state to successfully defend its waiver in court, and it implemented work requirements in 2023.

The OBBBA also expanded work requirements for the Supplemental Nutrition Assistance Program (SNAP). Click here to read Ballotpedia's coverage of these provisions.

What else does HB 2 do and what else did Beshear veto

Beshear vetoed 12 different sections of the HB 2 text. Among these sections are provisions concerning copays for Medicaid recipients, a provision that defines prohibited benefits, and the provision related to the time period beneficiaries are required to demonstrate compliance with Medicaid work requirements prior to enrollment.

The provision regarding copays that Beshear vetoed requires Medicaid recipients to pay a $5 copay for care, items, or services. In his veto statement, the governor wrote that he vetoed this section because it would prevent the state from collecting federal dollars and because the $5 copayment amount was overly prescriptive. He did not veto the section of the bill that requires recipients to pay a $1 copay for prescription drugs.

The copay portion of the bill states that the state will not "provide any Medicaid benefit or expend general fund moneys on any Medicaid benefit not expressly authorized by the General Assembly or required under federal law." The governor said that he vetoed this section to avoid excluding many medical services from Medicaid coverage, writing that under the current Medicaid program, many services are covered that are not in state statute or federal law.

Regarding his veto of the section of HB 2 that requires three months of work requirements compliance, Beshear wrote, "I am vetoing this part because it imposes a more strict requirement than currently in place, requiring administrative and system complexity which will be difficult to implement. It also will likely result in the loss of Medicaid eligibility because the more strict requirement will create unnecessary barriers for individuals. The more strict requirement does not recognize that individuals experience fluctuations in employment, health, caregiving responsibilities, or access to opportunities, and would penalize them for temporary gaps. The more strict requirement will create confusion and lead to otherwise eligible members losing coverage."

Section 71119 of the OBBBA allows states flexibility when determining how long applicants need to demonstrate compliance with the work requirements prior to being granted benefits. It requires states to require at least one month of compliance, but no more than three months of compliance for applicants.

Other states

Since the enactment of the OBBBA, states have taken actions to implement the work requirements early and or codify them in state law. Not all states plan to implement the requirements in the same way. Listed below are some other state actions related to the implementation of Medicaid work requirements:

• Nebraska will be the first state to implement the Medicaid work requirements required by the OBBBA on May 1. The state is using a state plan amendment to implement the new policy.
• Montana will also be implementing the work requirements early, beginning in July of this year.
• Arkansas has announced that the state will be implementing the work requirements on July 1, but that no one will face consequences, such as loss of benefits, for noncompliance until January 1, 2027.
• Missouri HJR154, which passed the House on February 19, would codify Medicaid work requirements in the state constitution and similarly require individuals to demonstrate compliance with work requirements for the month before they apply for benefits.
• Idaho HB 913, which was signed into law on April 10, codifies the work requirements in Idaho law, but also establishes a requirement that individuals demonstrate compliance with work requirements for three consecutive months before they are eligible to enroll in Medicaid.
• Indiana SB0001, which was signed into law on March 4, also establishes Medicaid work requirements and a requirement that individuals demonstrate compliance with work requirements for three consecutive months before they are eligible to enroll in Medicaid.