As Medicaid work rules for some beneficiaries begin in January, Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio will require documentation for medical exemptions immediately, rather than accept self-attestation during the first year.
The mandate covers up to 20 million lower-income adults without children at home enrolled through Medicaid expansion in 40 states and D.C.; the 10 states that did not expand Medicaid are excluded. Covered people must work or volunteer at least 80 hours a month or attend school at least half-time, with exceptions including medical frailty. The Congressional Budget Office projected $887 billion in federal savings over 10 years and 7.5 million fewer people insured. Democrats in 25 states are suing, arguing the rules are too harsh.
Federal rules allow self-attestation during the first year; starting in 2028, states may accept it once at enrollment, then must require documentation at least every 12 months. A June rule from the Centers for Medicare and Medicaid Services says a condition must “significantly impair” a person’s ability to work, volunteer or attend school to qualify for the medical-frailty exception. Supporters say documentation helps prevent fraud, while patient advocates warn it could keep eligible people from coverage.
