Medicaid work rules to start in January as six GOP states demand proof of frailty

September 27, 2026 at 04:20 AM1 min

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Work requirements for some Medicaid beneficiaries begin across the U.S. in January under President Donald Trump's 2025 tax and policy law. At least six Republican-led states will require immediate documentation of medical frailty, exceeding federal rules that allow self-attestation for the first year. Democrats in 25 states are suing to block the changes.

Key Facts

The Medicaid changes are projected to save the federal government $887 billion over the next decade and result in 7.5 million fewer people with health insurance, according to the Congressional Budget Office's 2025 estimate.
Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio have laws or policies barring self-attestation for the work requirement exception starting next year.
Democrats in 25 states are suing, asserting that the rules are too harsh.
Missouri Republican state Rep. Darin Chappell plans to reintroduce a constitutional amendment next year requiring documentary evidence of work or exemptions.

Documentation Requirements

Federal regulations allow states to accept a beneficiary's word for medical frailty for the first year, but at least six states are requiring documentation immediately. Jennifer Tolbert, director of state health policy and data at KFF, said someone may be unable to work but cannot afford a doctor to provide the required documentation. The conservative Foundation for Government Accountability has urged states to reject self-attestation, calling it 'fraud-by-design.' Self-attestation is made under penalty of perjury, though criminal charges for false statements are rare.

State Actions

Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio have laws or policies that bar self-attestation for the work requirement exception starting next year. Missouri Republican state Rep. Darin Chappell worked with the Foundation for Government Accountability on a proposed constitutional amendment requiring documentary evidence. The amendment passed the Missouri House but died without a vote in the Senate; Chappell plans to try again next year.