State Implementation Profiles

John Williams divides his year between commercial fishing in Bristol Bay during summer months and subsistence hunting in his home village of Dillingham during winter.

A 33-year-old man in Wilcox County, one of Alabama's poorest Black Belt counties, works as a timber cutter earning approximately $13,000 annually.

On January 28, 2025, Governor Sarah Huckabee Sanders stood at a podium in the Arkansas State Capitol and announced what she framed as a fresh start.

The lettuce worker in Yuma makes $16.50 an hour during harvest season.

On January 29, 2026, the California Department of Health Care Services released a document that no one in Sacramento ever expected to write.

The Colorado Department of Health Care Policy and Financing posted its work requirements FAQ in October 2025 with measured language reflecting the state's pragmatic assessment.

Sarah Martinez works 65 hours monthly at two part-time retail positions in Hartford, falling 15 hours short of the 80-hour requirement beginning January 2027.

Marcus Johnson works 25 hours weekly at a nonprofit advocacy organization in Ward 7, earning just enough to qualify for DC Medicaid under current expansion rules.

Sussex County patients drive 50 miles to see specialists or wait more than six months for primary care appointments, according to testimony that shaped Delaware's $1 billion …

A 38-year-old hospitality worker in Orlando earns $16,000 annually serving tables at a theme park restaurant.

When CMS Administrator Mehmet Oz praised Georgia's Pathways to Coverage program in September 2025 as "a very smart path for states who are not expanding Medicaid," he was …

Keoni Nakamura works two part-time jobs on Maui, one at a resort restaurant and another doing grounds maintenance for a condominium complex.

In April 2025, Governor Kim Reynolds stood at a podium in Des Moines and announced what she called common-sense policy: Iowa would require able-bodied adults on the Iowa Health and …

The Idaho House Health and Welfare Committee hearing room in March 2025 overflowed with opponents.

Illinois built its Medicaid architecture on a specific premise: that healthcare access should reduce barriers to self-sufficiency, not create new ones.

Elkhart County, Indiana, builds roughly 80% of the recreational vehicles sold in America.

A 37-year-old woman in Barber County, rural southwestern Kansas, works at a local grain elevator earning approximately $14,000 annually.

On the night of March 14, 2025, at approximately 9:15 p.m.

On December 12, 2025, the Louisiana Department of Health announced it would not renew UnitedHealthcare's contract to serve Medicaid managed care enrollees, reducing the state's MCO …

Maria Santos has navigated the Massachusetts healthcare system since 2008, when a car accident left her with chronic pain and limited her ability to work full-time.

Jessica Rodriguez works 75 hours monthly between two part-time jobs in Baltimore, one as a restaurant server and another doing overnight stocking at a retail store.

Robert Chen works seasonal tourism jobs in Bar Harbor, averaging 90 hours monthly during summer when cruise ships arrive but dropping to 40 hours during Maine's long winter.

Robert Gordon spent more than $30 million and a year of his life building what he believed was the best possible Medicaid work requirement system.

The Minnesota Department of Human Services webinar in August 2025 walked navigators and community partners through the Medicaid provisions in H.R.

The hearing room in the Missouri Capitol was tense on January 16, 2026.

A 29-year-old woman in Lowndes County works two part-time jobs, one at a fast-food restaurant and one cleaning offices at night.

The drive from Billings to Glasgow covers 280 miles of grassland and grain elevator towns, a distance that feels longer in January when the wind chill drops to forty below and the …

North Carolina has no prior work requirement implementation experience.

Williams County produces more than 500,000 barrels of oil daily from the Bakken Formation, creating employment patterns that defy traditional verification assumptions.

On December 17, 2025, Governor Jim Pillen announced that Nebraska would become the first state in the nation to implement Medicaid work requirements under the One Big Beautiful …

New Hampshire's compact geography creates a distinctive implementation landscape.

When New Jersey Human Services Commissioner Sarah Adelman testified before the state legislature in late 2025, she offered a number that reframed the entire work requirement debate …

Rosa Gutierrez works 30 hours weekly as a home health aide in Deming, one of fifteen New Mexico hospitals in the top 10 percent nationally for Medicaid patient share.

Las Vegas employs more than 300,000 people in leisure and hospitality, the sector that defines Nevada's economy and creates the state's distinctive work requirement implementation …

When Governor Kathy Hochul stood before cameras on September 10, 2025, announcing the state's decision to terminate its groundbreaking Essential Plan expansion, she was describing …

On November 7 and 12, 2025, the Ohio Department of Medicaid hosted a pair of webinars that offered the most detailed picture yet of how any large state plans to operationalize …

Governor Kevin Stitt stood before a joint session of the Oklahoma legislature on February 2, 2026, his hand visibly bandaged from a cooking accident, and delivered a metaphor that …

The Oregon Health Authority quietly updated its public-facing information in late 2025.

Governor Josh Shapiro did not mince words.

Maria Silva works 70 hours monthly between two jobs in Providence, one cleaning houses and another doing food preparation at a catering company.

On January 21, 2025, Governor Henry McMaster sent a letter to Acting HHS Secretary Dorothy Fink requesting the reinstatement of South Carolina's Healthy Connections Community …

The Department of Social Services conference room in Pierre was nearly empty when Secretary Matt Althoff announced the obvious in July 2025.

A 35-year-old mother in rural Appalachian Tennessee works part-time at a local retail store earning approximately $9,500 annually.

A 42-year-old construction worker in Laredo earns $14,000 annually, well below the federal poverty level of $15,060 for a single adult.

On May 14, 2025, a month before the One Big Beautiful Bill Act became law, Angie Garcia told a Utah Department of Health and Human Services public hearing about her daughter …

Abigail Spanberger took the oath of office as Virginia's 74th governor on January 17, 2026, becoming the first woman to lead the Commonwealth.

Michael Thompson lives in Caledonia County in Vermont's Northeast Kingdom, working seasonally at a ski resort and doing construction when weather permits.

In July 2025, the Washington State Senate Health and Long-Term Care Committee convened to discuss the implications of H.R.

On the Wisconsin Department of Health Services website, updated in late 2025, a page titled "Federal Changes" opens with measured bureaucratic language: "The budget reconciliation …

Governor Patrick Morrisey stood before West Virginia's legislature in January 2026, outlining his vision for the state's future.

A 42-year-old man in Sublette County, rural western Wyoming, works seasonally at a natural gas extraction site earning approximately $18,000 during the six-month work season.