A number of states that have resisted expanding their Medicaid programs are now attempting to do so by linking expansion to requiring new participants to enroll in job search and training programs.

The Centers for Medicare & Medicaid Services, which must approve Medicaid expansion plans, has rejected proposals from Indiana, Montana, and New Hampshire that had such requirements and is currently reviewing a similar proposal from Arkansas. Arkansas already has expanded its Medicaid program but is threatening to drop its expansion unless CMS permits it to modify its current approach.

CMS does not prevent states from incorporating job search and employment training into their Medicaid programs but so far has not permitted them to make participation in such efforts mandatory.

For a closer look at this issue, including what states are proposing and how CMS is responding, see this CQ Roll Call report presented by the Commonwealth Fund.