While last year’s H.R. 1, often referred to as the “One Big Beautiful Act Bill,” introduced a requirement that Medicaid applicants document that they have worked, attended school, or participated in some form of community engagement for one month as a condition of eligibility for the program, a few states are looking to make that requirement more rigorous.

Indiana, for example, has turned that one-month requirement into three months and Missouri, Arizona, and Kentucky are considering increasing the requirement as well.

Missouri officials are even proposing a constitutional amendment that would ban the state from expanding the scope of current hardship exemptions to the work/community engagement requirement.

Such developments would likely have a disproportionate impact on community safety-net hospitals, which serve areas with larger numbers of low-income and uninsured residents and would therefore find themselves serving even more uninsured patients than they already do.

Learn more about how states are implementing, or considering implementing, the new Medicaid work/community engagement requirement from the KFF Health article “New Federal Medicaid Rules Require One Month of Work.  Some States Demand More.”