While HR 1 and the federal government set many standards for work reporting requirements, states have considerable influence over how work reporting requirements are implemented and how they affect adults who rely on Medicaid coverage.
States must make important policy and operational decisions – such as which data sources to use to verify compliance with or exceptions to work requirements; whether to adopt hardship exemptions for extenuating circumstances; how often to conduct compliance checks; and how the state determines exemptions from work requirements for individuals who are medically frail. They must update their systems, develop multi-faceted outreach plans, and likely need to hire additional staff.
This page includes data and resources to monitor implementation of work reporting requirements across states, including state-level policy and operational decisions.
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The New Medicaid Work Reporting Requirements Are Here—Don’t Let the Nebraska “Soft Start” Fool You
On May 1, 2026, Nebraska became the first state to start the new work requirements under H.R. 1, the law passed last year making historic cuts to Medicaid. We have reported extensively on why work reporting requirements are a bad idea. Nebraska was not adequately prepared to launch work reporting requirements, nor has the Centers…
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Congress Wanted to Protect People Living in Areas with High Unemployment from Losing Health Care Due to Work Reporting Requirements. Will it Actually Happen?
During the Congressional debate about the passage of H.R. 1, many concerns were raised about the adoption of a mandatory work reporting requirement for people covered by Medicaid expansion – including the risks of people living in areas with high unemployment losing health coverage despite their best efforts to find work. In response, statutory language…
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New Report Highlights State Data, Strategies to Protect Pregnant and Postpartum Women from Losing Medicaid Coverage Due to Red Tape
As states press forward to implement the newly required work reporting requirements (WRRs) for Medicaid expansion adults starting next year, researchers at Georgetown CCF remain concerned about coverage losses among those adults who do everything right but still fall through the cracks and become disenrolled. Leo Cuello, Joan Alker and others at CCF have detailed…
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How are H.R. 1 Cuts and Changes to Medicaid and SNAP Playing out in 2026 State Legislative Sessions So Far?
Following the enactment of the largest Medicaid cuts in history, we anticipated a flurry of Medicaid activity in state legislative sessions. State legislators were left to fill the budget holes made by H.R.1, figure out how to implement H.R.1-mandated policies like work reporting requirements, and (hopefully) mitigate some of the associated coverage losses. Ten state…
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Let’s Start a Conversation about Data to Monitor the Impact of H.R. 1’s Work Reporting Requirements
Monitoring the implementation of work reporting requirements in Medicaid will be incredibly important to assessing the policy’s impact, identifying bottlenecks or glitches in the system, and enabling rapid response to address problems. We have a baseline of data from the Medicaid performance indicators, which have been in place since 2014, and were expanded to more…
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CMS’s Georgia Waiver Extension Underscores the Failure of Medicaid Work Requirements
As regular readers of SayAhhh! know, on January 1, 2027, 42 states and DC will be required by HR 1 to impose work reporting requirements on many adults covered by Medicaid. The only state in the country that is currently implementing work reporting requirements is Georgia through a Section 1115 demonstration — officially known as…
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How Will We Know if States are Ready to Implement HR 1 and Work Reporting Requirements? Follow the State Performance Metrics Here.
States are just emerging from the unwinding of the pandemic-related Medicaid continuous enrollment provision when HR 1 presents a host of state budget impacts and new administrative hurdles for states. If states are already having trouble keeping up with their eligibility and enrollment administrative workload, adding work reporting requirements, six-month renewals, and mandatory cost sharing…
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Are States Ready to Implement HR 1 and Medicaid Work Reporting Requirements?
Key Findings Introduction On July 4, 2025, President Trump signed into law HR 1 (P.L. 119-21), the massive budget reconciliation bill that cuts more than $1 trillion from Medicaid and Marketplace health coverage. The law strips coverage from many lawfully residing immigrants, ties the hands of states to raise revenue to cover the state share…
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How Do We Know Congress’s Work Requirements in Medicaid Will Fail? They Already Have.
As expected, the House’s rushed attempt to finance the Trump Administration’s immigration and tax agenda by cutting Medicaid includes a “work requirement.” Proponents claim that it is intended to support employment but it does no such thing. In fact, it’s a policy that takes health insurance away from millions of people, including workers. This policy…