State Implementation Profiles on Syam Adusumilli

Alaska: Work Requirements in America's Last Frontier

Sun, 15 Feb 2026 00:00:00 +0000

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. He earns enough during fishing season to qualify for Medicaid expansion, but his documented wage records show zero income from November through March when he provides for his family through hunting, fishing, and gathering. Under work requirements beginning January 2027, his summer commercial fishing wages might qualify him through income averaging provisions recognizing Alaska’s seasonal economy. But if he cannot successfully navigate income-based verification or if the state requires monthly hour documentation instead, will his subsistence activities count as qualifying work? Who would verify hours spent hunting and fishing for household consumption in a village accessible only by air?

Summary: Alaska: Work Requirements in America's Last Frontier

Sun, 15 Feb 2026 00:00:00 +0000

Alaska implements Medicaid work requirements in America’s last frontier, where more than 200 communities are accessible only by aircraft or water, where subsistence economies provide household resources that generate no wage records, and where seasonal commercial fishing generates substantial income during limited periods but zero documented employment during off-seasons. The state’s expansion population, while exempting Alaska Native and American Indian individuals eligible for Indian Health Service coverage, must navigate verification systems designed for lower-48 urban labor markets in an environment where those assumptions collapse.

Article 14.AL: Alabama

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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. He has hypertension and diabetes but cannot afford medications or regular doctor visits. He has no dependent children. He earns too much for Alabama Medicaid, which caps parent eligibility at 18% of the federal poverty level and categorically excludes childless adults. He earns too little for marketplace premium subsidies, which begin at 100% of poverty. The nearest hospital is 45 minutes away. The hospital closed its emergency department three years ago, converting to an outpatient-only facility. He represents one of approximately 92,000 to 128,000 Alabamians in the coverage gap: working poor in healthcare deserts, excluded from coverage because Alabama chose not to expand Medicaid.

Summary: Article 14.AL: Alabama

Sun, 15 Feb 2026 00:00:00 +0000

Alabama maintains one of the strictest Medicaid eligibility structures nationally, with parent eligibility capped at 18% FPL (approximately $4,800 annually for a family of three), tied with Texas as the most restrictive. The coverage gap population is approximately 92,000 to 128,000 adults, though full expansion would cover 200,000 to 340,000 individuals. Federal work requirements under H.R. 1 do not apply because Alabama never expanded Medicaid. However, Alabama’s 2018 Section 1115 waiver proposal reveals the most aggressive work requirement approach proposed by any state: 35 hours weekly (approaching full-time employment) for parents with children aged six or older, targeting existing Medicaid populations that federal law exempts. The proposal created a fundamental catch-22: parents meeting the 35-hour weekly work requirement at minimum wage would earn approximately $1,260 monthly, far exceeding the 18% FPL income threshold, causing compliance to trigger income-based termination. The waiver remains in administrative limbo after pandemic suspension, never approved or formally withdrawn. Alabama demonstrates maximum aggressive work requirement philosophy applied to populations already working and earning poverty-level incomes.

Article 14.AR: Arkansas

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 state was submitting a new Section 1115 waiver amendment requesting work requirements for ARHOME, the state’s Medicaid expansion program. The proposal was called “Pathway to Prosperity,” and Sanders described it as fundamentally different from what came before. “This new waiver reduces administrative hurdles and other issues for legitimate Medicaid expansion recipients while still achieving our policy goal: to have Medicaid serve as a safety net rather than a poverty trap,” the governor told reporters. DHS Secretary Kristi Putnam added that the approach was “not punitive” but rather “about purpose.”

Summary: Article 14.AR: Arkansas

Sun, 15 Feb 2026 00:00:00 +0000

Arkansas is the only state that has actually implemented and disenrolled people under Medicaid work requirements. In 2018-2019, 18,164 adults lost coverage over nine months. New England Journal of Medicine research documented that 95% who lost coverage had been working or qualified for exemptions. No employment increase was detected. Coverage losses concentrated in Mississippi Delta counties where poverty, poor health, and limited infrastructure were already most severe. On January 28, 2025, Governor Sarah Huckabee Sanders announced “Pathway to Prosperity,” a Section 1115 waiver amendment requesting work requirements for ARHOME. The waiver was submitted to CMS on April 10, 2025, targeting January 1, 2026. But OBBBA signed July 4, 2025, established federal work requirements effective January 1, 2027, nationwide. Arkansas now attempts to demonstrate it has learned from failure while preparing for federal mandates that may impose harder standards than its deliberately softer approach.

Article 14.AZ: Arizona

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Medicaid Work Requirements

The lettuce worker in Yuma makes $16.50 an hour during harvest season. From November through March, she works sixty hours a week in fields that produce ninety percent of America’s winter leafy vegetables. By June, the fields are dormant and her agricultural hours drop to zero. Under the federal work requirement mandate signed into law on July 4, 2025, she needs eighty hours monthly of qualifying activity. Five months of the year, she exceeds that threshold by a factor of three. The other seven months, the system sees a woman who isn’t working.

Summary: Article 14.AZ: Arizona

Sun, 15 Feb 2026 00:00:00 +0000

Arizona’s work requirement implementation asks whether a policy designed for uniform national application can function across the extremes this state contains: tribal sovereignty on the Navajo Nation, seasonal agriculture in Yuma County’s lettuce fields, international border economics, extreme geography spanning 114,000 square miles, and the nation’s most mature Medicaid managed care infrastructure. Approximately 400,000 to 450,000 expansion adults face 80-hour monthly requirements beginning December 2026, but Arizona’s distinction is not population size. It is the diversity of circumstances that population contains, making the state a test case for whether standardized federal policy can accommodate the varied terrain of American lives.

Article 14.CA: California

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

On January 29, 2026, the California Department of Health Care Services released a document that no one in Sacramento ever expected to write. The H.R. 1 Implementation Plan laid out, in clinical detail, how a state that had spent a decade expanding Medicaid access to every conceivable population would now condition that access on 80 hours of monthly work, education, or community engagement for nearly five million people. The plan acknowledged what everyone in California health policy already knew: the state’s ex parte renewal rates had dropped back to pre-unwinding levels after federal flexibilities expired in July 2025, meaning the administrative machinery was already straining before the largest new compliance burden in Medicaid history arrived on top of it.

Summary: Article 14.CA: California

Sun, 15 Feb 2026 00:00:00 +0000

California’s DHCS released its H.R. 1 Implementation Plan on January 29, 2026, detailing how it will condition Medicaid access on work requirements for approximately 5 million expansion adults. This represents 20.5% of all expansion adults nationally, exceeding the combined expansion populations of the next three largest states. Urban Institute projects 1.2 to 1.4 million Californians could lose coverage, while UC Berkeley’s Labor Center estimates 8 million total Medi-Cal enrollees face risk when accounting for simultaneous federal and state policy changes. California confronts federal work requirements it philosophically opposes and cannot legally avoid, implemented atop state-level budget cuts creating unprecedented policy collision. Among expansion adults, 68% already work (42% full-time, 26% part-time), meaning the challenge centers on documentation and verification rather than employment creation.

Colorado: County Administration Meets Federal Timeline

Sun, 15 Feb 2026 00:00:00 +0000

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. The department was preparing for changes and would share more information as the federal government released final rules by June 2026. These frequently asked questions were based on information known as of the publish date and would be updated as federal guidance became available over the coming months.

Summary: Colorado: County Administration Meets Federal Timeline

Sun, 15 Feb 2026 00:00:00 +0000

Colorado faces Medicaid work requirements with compressed timeline that provides insufficient time to build massive systems required across 64 counties ranging from Denver’s sophisticated infrastructure to tiny Mineral County’s minimal staffing. The Colorado Department of Health Care Policy and Financing posted work requirements FAQ in October 2025 with measured language reflecting pragmatic assessment: the department was preparing for changes and would share more information as federal government released final rules by June 2026. Federal work requirements create administrative complexities and costs that strain budgets under funding model that doesn’t account for this type of work in Medicaid. CMS guidance arriving in June 2026 provides insufficient time to meet January 1, 2027 federal mandate.

Connecticut: Work Requirements Meet Fee-for-Service Medicaid

Sun, 15 Feb 2026 00:00:00 +0000

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. She enrolled in HUSKY D when Connecticut became the first state to implement Medicaid expansion in 2010, well before the Affordable Care Act required it. Her income qualifies her for coverage, but neither retail job offers full-time hours or health benefits. Starting next year, Sarah will need to document her work hours or find additional qualifying activities to maintain coverage. If community college courses counted toward requirements, she could combine work with education. But will Connecticut’s fee-for-service Medicaid system, operating without managed care organization infrastructure that other states rely on, have capacity to provide navigation assistance she needs?

District of Columbia: The Federal Territory Faces Federal Mandates

Sun, 15 Feb 2026 00:00:00 +0000

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. His position offers meaningful work advocating for affordable housing but no health benefits and no full-time hours. Starting January 2027, Marcus will need to document 80 hours monthly of work or other qualifying activities to maintain his health coverage. He could potentially combine his advocacy work with volunteer hours at his neighborhood community center to reach requirements. But if his nonprofit reduces hours due to federal funding cuts, will he know how to document exemptions? Will the District’s verification systems recognize his situation before terminating coverage?

Article 14.DE: Delaware

Sun, 15 Feb 2026 00:00:00 +0000

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 application to the Rural Health Transformation Program. The state received $157.4 million for fiscal year 2026 in late December, funding that Governor Matt Meyer describes as a once-in-a-generation opportunity to overhaul healthcare in every community. That investment addresses infrastructure and workforce, but it does not substitute for the coverage stability that approximately 70,000 expansion adults depend upon as work requirements approach implementation.

Summary: Article 14.DE: Delaware

Sun, 15 Feb 2026 00:00:00 +0000

Delaware received $157.4 million in late December 2025 from the Rural Health Transformation Program, funding that Governor Matt Meyer describes as a once-in-a-generation opportunity to overhaul healthcare in every community. Sussex County patients drive 50 miles to see specialists or wait more than six months for primary care appointments. The state ranks worst in the nation for primary care access. That investment addresses infrastructure and workforce but does not substitute for the coverage stability that approximately 70,000 expansion adults depend upon as work requirements approach implementation. The collision between Delaware’s largest rural health investment in history and a federal mandate threatening coverage for the population that investment aims to serve defines the state’s implementation paradox.

Article 14.FL: Florida

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

A 38-year-old hospitality worker in Orlando earns $16,000 annually serving tables at a theme park restaurant. She works 30-35 hours weekly, depending on tourist season. She has chronic asthma but cannot afford controller medications or specialist care. She has no dependent children. She earns too much for Florida Medicaid, which caps parent eligibility at 28% of the federal poverty level and categorically excludes childless adults. She earns too little for marketplace premium subsidies, which begin at 100% of poverty. She represents one of approximately 388,000 Floridians in the coverage gap: too poor for subsidized insurance, too healthy for disability coverage, too childless for parent coverage, caught between policy architectures that assume everyone fits neatly into categorical boxes.

Summary: Article 14.FL: Florida

Sun, 15 Feb 2026 00:00:00 +0000

Florida maintains the second largest coverage gap nationally with approximately 388,000 adults earning too little for marketplace subsidies but excluded from Medicaid because Florida never expanded under the ACA. Federal work requirements under H.R. 1 do not apply because Florida has no expansion population. The state operates one of the largest and most mature Medicaid managed care programs nationally, serving approximately 4.2 to 4.3 million individuals (predominantly children, elderly, and disabled populations) through ten MCOs. Governor Ron DeSantis and the Republican-controlled legislature have consistently opposed expansion, with Senate President Kathleen Passidomo calling expansion “a false government promise” in 2025. Florida Decides Healthcare launched a citizen-led ballot initiative for November 2026 that suspended operations in September 2025 after HB 1205 legislation dramatically increased petition costs and restrictions. The campaign shifted its target to the 2028 ballot cycle, with legal challenges to HB 1205 proceeding in federal court. Polling consistently shows approximately two-thirds of Florida voters support expansion, including a slim majority of Republicans.

Article 14.GA: Georgia

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 describing a program that had enrolled roughly 8,000 people against projections of 100,000, spent $110 million doing so, and never actually enforced the work verification system it was built around. Two months later, when the One Big Beautiful Bill Act created a federal work requirement mandate effective January 1, 2027, Georgia found itself in a position no other state occupies: operating America’s only active Medicaid work requirement while simultaneously preparing for a federal mandate whose parameters may not align with the program already running.

Summary: Article 14.GA: Georgia

Sun, 15 Feb 2026 00:00:00 +0000

Georgia operates the nation’s only active Medicaid work requirement through Pathways to Coverage while preparing for federal requirements under H.R. 1 effective January 1, 2027. The Trump administration extended Georgia’s waiver through December 31, 2026, with modifications effectively acknowledging operational failures. A September 2025 GAO report revealed two-thirds of total Pathways spending went to administrative costs rather than healthcare in the first 15 months. Only 8,077 people were actively covered as of June 2025 against initial projections of 100,000. Per-enrollee costs reached approximately $13,597 compared to estimated $496 under full Medicaid expansion with 90% federal matching rates. Georgia faces dual-policy challenge: managing Pathways under one set of rules while preparing for federal requirements under different parameters starting January 2027.

Hawaii: Work Requirements Across the Pacific

Sun, 15 Feb 2026 00:00:00 +0000

Keoni Nakamura works two part-time jobs on Maui, one at a resort restaurant and another doing grounds maintenance for a condominium complex. Between both jobs he averages 70 hours per month, falling 10 hours short of the 80-hour monthly work requirement beginning January 2027. His combined income qualifies him for Med-QUEST expansion coverage. Neither employer offers health benefits or guaranteed hours. Starting next year, Keoni will need to document his work hours or find additional qualifying activities to maintain his health coverage. If job training programs existed within reasonable distance of his home in Lahaina, he might combine work with education to meet requirements. But after the August 2023 wildfires devastated Lahaina, community resources remain limited and Keoni splits his time between work and helping with ongoing family recovery efforts.

Article 14.IA: Iowa

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 Wellness Plan to prove they were working, training, or studying in order to keep their health coverage. “If you are an able-bodied adult who can work, you should work,” Reynolds said. The statement would have been unremarkable in the context of a national debate over Medicaid work requirements, except for one detail that made Iowa’s approach analytically distinctive. While Congress was finalizing the One Big Beautiful Bill Act with its 80-hour monthly floor, Iowa’s Department of Health and Human Services submitted a waiver to CMS requesting authority to require 100 hours per month, 25% above the federal minimum. The state legislature, through SF 615, codified 80 hours as the statutory floor while the executive branch simultaneously pursued a higher threshold through the waiver process. Iowa became the first state to signal that the federal mandate was not a ceiling but a starting line.

Summary: Article 14.IA: Iowa

Sun, 15 Feb 2026 00:00:00 +0000

Iowa’s unemployment rate hovers around 2.8 to 3.2%, consistently among the lowest nationally. Every community except Decatur County posted unemployment below 4% in December 2025. The state has 80,000 to 100,000 unfilled job openings. Iowa is not implementing work requirements in a job scarcity environment but in a labor shortage. This fundamentally shapes policy logic and reveals work requirements as primarily documentation challenges rather than employment incentives.

Senate File 615 passed 33-15 in the Senate on March 25, 2025, and 61-35 in the House the next day. Governor Kim Reynolds signed the bill in June 2025. The legislature set work threshold at 80 hours monthly. The governor’s waiver request, submitted to CMS on June 6, 2025, set the bar at 100 hours monthly. By February 2026, practical resolution appeared to be convergence toward 80-hour federal standard. Iowa Health and Wellness Plan covers approximately 180,000 to 200,000 expansion adults. After exemptions, the population subject to requirements ranges from 100,000 to 130,000.

MRWR-14ID: Idaho

Sun, 15 Feb 2026 00:00:00 +0000

The Idaho House Health and Welfare Committee hearing room in March 2025 overflowed with opponents. After two hours of overwhelmingly negative testimony, 167 people signed up in opposition online versus 15 in support, the committee voted along party lines to advance House Bill 345 to the floor. The bill represented the legislature’s third attempt to fundamentally alter Medicaid expansion that voters had approved without conditions in 2018. Earlier proposals had sought outright repeal or conditional triggers that would automatically end expansion if specific waivers weren’t obtained. HB 345 took a different approach: accept expansion’s permanence but reshape it through work requirements, managed care privatization, cost-sharing mandates, and marketplace premium tax credit alternatives.

Summary: MRWR-14ID: Idaho

Sun, 15 Feb 2026 00:00:00 +0000

Idaho implements Medicaid work requirements in January 2027 through an extraordinary convergence: state legislation enacted before the federal mandate arrived, a voter-approved expansion the legislature never supported, and a rural geography that challenges every assumption embedded in work verification systems. The state’s 89,400 expansion adults, enrolled through a 2018 ballot initiative that passed with 61 percent support, face requirements created by a legislature that opposed expansion from the beginning and that used House Bill 345 in March 2025 to fundamentally reshape the program voters approved without conditions.

Article 14.IL: Illinois

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

Illinois built its Medicaid architecture on a specific premise: that healthcare access should reduce barriers to self-sufficiency, not create new ones. In 2024, the state secured CMS approval for a Healthcare Transformation 1115 waiver that authorized coverage of violence prevention services, housing supports, and pre-release services for incarcerated individuals. In 2025, the legislature expanded eligibility for the Health Benefits for Immigrant Adults program downward to age 42, and the state launched Get Covered Illinois as a state-based marketplace with $6.5 million in navigator grants. These were investments in a coverage philosophy that viewed Medicaid as infrastructure for economic mobility. Then H.R. 1 arrived, and the infrastructure designed to remove barriers became the infrastructure tasked with enforcing a new one.

Summary: Article 14.IL: Illinois

Sun, 15 Feb 2026 00:00:00 +0000

Illinois built its Medicaid architecture on a premise that healthcare access should reduce barriers to self-sufficiency, not create new ones. In 2024, the state secured CMS approval for a Healthcare Transformation 1115 waiver authorizing coverage of violence prevention services, housing supports, and pre-release services for incarcerated individuals. In 2025, the legislature expanded eligibility for the Health Benefits for Immigrant Adults program and the state launched Get Covered Illinois as state-based marketplace with $6.5 million in navigator grants. These were investments in a coverage philosophy that viewed Medicaid as infrastructure for economic mobility. Then H.R.1 arrived, and infrastructure designed to remove barriers became infrastructure tasked with enforcing a new one.

Article 14.IN: Indiana

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Medicaid Work Requirements

Elkhart County, Indiana, builds roughly 80% of the recreational vehicles sold in America. When the RV market is strong, the county’s unemployment rate drops below 2% and temporary staffing agencies run double shifts to meet demand. When orders fall, as they do cyclically in every recession and several times between them, layoffs cascade through the supply chain and unemployment can spike past 15% within months. A worker who logged 180 hours in March might report zero in June, not because she stopped trying to find work, but because the industry that employs her town evaporated overnight.

Summary: Article 14.IN: Indiana

Sun, 15 Feb 2026 00:00:00 +0000

Elkhart County builds roughly 80% of recreational vehicles sold in America. When the RV market is strong, unemployment drops below 2%. When orders fall, unemployment can spike past 15% within months. Three hundred miles south, Dana Simons runs the Next Step Foundation, where 14 peer recovery coaches serve roughly 100 Hoosiers battling substance use disorders. Every client is enrolled in the Healthy Indiana Plan. When Senate Bill 2 moved through the legislature in early 2025, Simons warned that layering Medicaid verification on top of treatment compliance creates “one more layer where things can go wrong.”

Article 14.KS: Kansas

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

A 37-year-old woman in Barber County, rural southwestern Kansas, works at a local grain elevator earning approximately $14,000 annually. She has no employer-sponsored health insurance. She has asthma that worsens each harvest season from dust exposure, but she cannot afford an inhaler or preventive medications. She has no dependent children. She earns too much for Kansas Medicaid, which caps parent eligibility at approximately 38% of the federal poverty level. She earns too little for marketplace premium subsidies, which begin at 100% of poverty. The nearest hospital is 30 miles away. That hospital is projected to close within two years due to financial strain. She represents one of approximately 27,000 to 39,000 Kansans in the coverage gap: working poor in crumbling healthcare infrastructure, excluded from coverage because Kansas chose not to expand Medicaid.

Summary: Article 14.KS: Kansas

Sun, 15 Feb 2026 00:00:00 +0000

Kansas remains one of ten states that declined Medicaid expansion, leaving approximately 27,000 to 39,000 adults in the coverage gap with no affordable coverage option. The state faces the highest percentage of rural hospitals at risk of closure nationally: 67 of approximately 100 rural hospitals (67%) are at risk, with 30-31 at immediate closure risk within two to three years. Eight rural hospitals have closed since 2015. Governor Laura Kelly introduced the Healthcare Access for Working Kansans (HAWK) Act in February 2025, her seventh consecutive annual expansion proposal with work requirements designed to attract Republican legislative support. The bill has not advanced. Federal work requirements under H.R. 1 do not apply to Kansas because the state has no expansion population, but the elimination of ARPA’s enhanced federal matching for newly expanding states reduced expansion’s financial attractiveness by eliminating an estimated $542 million in additional federal funding over two years.

Article 14.KY: Kentucky

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

On the night of March 14, 2025, at approximately 9:15 p.m. in a conference room steps from the Kentucky Senate floor, a committee substitute was introduced that transformed House Bill 695 from a Medicaid oversight measure into the latest chapter of the most tortured work requirement saga in American health policy. The substitute, which few legislators had seen before that evening, converted a voluntary community engagement program into a mandatory one, reinstated prior authorization requirements for behavioral health services, and created a Medicaid Oversight and Advisory Board that shifted significant program control from the executive to the legislature. The Senate passed the amended bill around 10:40 p.m. on a party-line vote. The House concurred less than an hour before the midnight deadline to end legislative business. Governor Andy Beshear vetoed the bill, calling it a measure that “would put up barriers to and delay health care for Kentuckians.” On March 27, the legislature overrode his veto: 29 to 7 in the Senate, 80 to 20 in the House, with a single Democrat, Representative Matthew Lehman, crossing party lines.

Summary: Article 14.KY: Kentucky

Sun, 15 Feb 2026 00:00:00 +0000

On March 14, 2025, around 9:15 p.m., a committee substitute transformed House Bill 695 from Medicaid oversight into mandatory work requirements. The Senate passed the amended bill around 10:40 p.m. on party-line vote. The House concurred less than an hour before midnight. Governor Andy Beshear vetoed the bill. On March 27, the legislature overrode his veto 29-7 in the Senate, 80-20 in the House. The override made Kentucky the most analytically instructive state in the work requirements landscape: it has tried this before, failed catastrophically, and is now compelled to try again under fundamentally different legal conditions.

MRWR-14LA: Louisiana

Sun, 15 Feb 2026 00:00:00 +0000

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 roster from six plans to five. The timing was significant. Four days earlier, CMS had issued its initial implementation guidance for H.R.1 work requirements. Louisiana was simultaneously restructuring the managed care infrastructure that would bear the operational burden of work requirement compliance while absorbing the policy itself. LDH spokesperson Sarah Herrock framed the administration’s posture in language that left no ambiguity about Governor Jeff Landry’s orientation: work requirements were “a means to grow our economy, while reinforcing the value of work and self-sufficiency.”

Summary: MRWR-14LA: Louisiana

Sun, 15 Feb 2026 00:00:00 +0000

Louisiana will implement work requirements with an enforcement orientation that its SNAP work requirement record makes explicit. Approximately 400,000 to 450,000 expansion adults face 80-hour monthly work requirements beginning December 2026, but Louisiana’s defining characteristic is not its affected population size or economic context. It is the Landry administration’s demonstrated commitment to reciprocal obligation requirements over accommodation-based implementation, making Louisiana the state most likely to pursue compliance verification as an enforcement mechanism rather than a support service.

Massachusetts: When Healthcare Reform Meets Work Requirements

Sun, 15 Feb 2026 00:00:00 +0000

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. She qualified for MassHealth CarePlus under the state’s Medicaid expansion, enabling her to access specialists, pain management, and physical therapy that make it possible for her to work 25 hours per week at a community health center in Chelsea. Starting January 2027, she will need to document 80 hours monthly of work, education, job training, or other qualifying activities to maintain her health coverage. Given her documented work hours, she will likely qualify. But if the chronic pain that already limits her employment worsens and she cannot maintain those hours, will she know how to document her medical exemption? Will the state systems recognize her situation before terminating her coverage?

Summary: Massachusetts: When Healthcare Reform Meets Work Requirements

Sun, 15 Feb 2026 00:00:00 +0000

Massachusetts approaches federal work requirement implementation from a position unlike any other expansion state. The commonwealth invented modern healthcare reform, achieving near-universal coverage through the 2006 reforms that became the blueprint for the Affordable Care Act. Work requirements represent policy logic fundamentally at odds with the shared responsibility model that made Massachusetts a national leader in coverage. Approximately 255,000 to 280,000 expansion adults face 80-hour monthly requirements beginning December 2026, but the state’s defining characteristic is not its affected population size or administrative capacity. It is the collision between a policy framework built on universal coverage principles and a federal mandate that conditions coverage on individual behavioral compliance.

Maryland: Work Requirements Meet Healthcare System Transformation

Sun, 15 Feb 2026 00:00:00 +0000

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. Neither job offers benefits or consistent scheduling. She enrolled in Maryland HealthChoice when the state expanded Medicaid in 2014. Starting January 2027, Jessica will need to document 80 hours monthly of qualifying activities to maintain coverage. Her unpredictable work schedules across two employers make hour tracking complicated, and neither employer provides documentation beyond pay stubs showing wages but not hours. Whether Maryland’s managed care organizations will provide navigation assistance to help her verify compliance, and whether the state’s simultaneous transition to the AHEAD healthcare payment model will support or distract from work requirement implementation, remains uncertain.

Summary: Maryland: Work Requirements Meet Healthcare System Transformation

Sun, 15 Feb 2026 00:00:00 +0000

Maryland faces unprecedented dual transformation unlike any other state: implementing Medicaid work requirements while simultaneously transitioning its entire hospital payment system from the Total Cost of Care model that ended December 31, 2025, to the AHEAD model beginning 2026. Approximately 300,000 to 330,000 expansion adults face 80-hour monthly requirements beginning December 2026, with potential coverage losses of up to 100,000 Marylanders. Deputy Health Secretary Perrie Briskin has warned that with all H.R.1 provisions fully implemented, Maryland could lose $2.7 billion in federal Medicaid funding, representing approximately 20 percent of current program funding. The state must build work requirement verification systems, exemption processing capacity, and member navigation infrastructure while managing a healthcare payment system transformation that affects every hospital in the state.

Maine: From Referendum Victory to Federal Mandate

Sun, 15 Feb 2026 00:00:00 +0000

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. He enrolled in MaineCare in 2019 when Governor Janet Mills finally implemented the Medicaid expansion that voters approved by referendum in 2017, overruling then-Governor Paul LePage’s refusal. Robert’s part-time year-round work at a local inn supplements his summer income but neither job offers benefits. Starting January 2027, he will need to document 80 hours monthly of qualifying activities throughout the year to maintain coverage. Whether seasonal income averaging provisions will accommodate tourism industry realities in coastal Maine, or whether construction work and other winter activities can be verified, remains uncertain.

Article 14.MI: Michigan

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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. As director of the Michigan Department of Health and Human Services under Governor Gretchen Whitmer, he had inherited a mandate from the Republican legislature and a clear instruction from the federal courts in Arkansas: do not repeat what happened there. His team reprogrammed eligibility systems, designed plain-language communications tested with actual enrollees, built phone and online reporting channels, trained navigators, and established automatic deemed compliance for people already meeting work requirements through SNAP or TANF. When work requirements took effect on January 1, 2020, Michigan was as ready as any state had ever been. And even so, Gordon’s own analysis showed that more than 100,000 Michiganders were on track to lose coverage within the year. “That’s the population of the city of Flint who were on track to lose their insurance,” he wrote in a May 2025 Commonwealth Fund essay. “We’re implementing this about as well as this thing can be implemented, and it is still going to be pretty catastrophic.”

Summary: Article 14.MI: Michigan

Sun, 15 Feb 2026 00:00:00 +0000

Michigan is the only state that has both attempted work requirements with genuine investment in implementing them well and concluded, from its own experience, that they cannot be implemented without significant coverage losses. Robert Gordon, director of the Michigan Department of Health and Human Services under Governor Gretchen Whitmer, spent more than $30 million and a year building what he believed was the best possible Medicaid work requirement system. His team reprogrammed eligibility systems, designed plain-language communications tested with actual enrollees, built phone and online reporting channels, trained navigators, and established automatic deemed compliance for people already meeting work requirements through SNAP or TANF. When work requirements took effect on January 1, 2020, Michigan was as ready as any state had ever been. Gordon’s own analysis showed that more than 100,000 Michiganders were on track to lose coverage within the year before a federal judge struck down the waiver in March 2020.

Minnesota: DFL Principles Meet Federal Reality

Sun, 15 Feb 2026 00:00:00 +0000

The Minnesota Department of Human Services webinar in August 2025 walked navigators and community partners through the Medicaid provisions in H.R. 1. At least 320,000 Minnesotans would likely be subject to work reporting requirement rules, approximately 23 percent of the state’s Medicaid population. The federal government must issue interim final rules by June 1, 2026. States must implement work requirements by December 31, 2026, though the HHS Secretary can exempt a state from compliance if the state demonstrates good faith effort. This exemption cannot be extended beyond December 31, 2028.

Summary: Minnesota: DFL Principles Meet Federal Reality

Sun, 15 Feb 2026 00:00:00 +0000

Minnesota approaches work requirement implementation having never imposed such requirements and viewing them as inconsistent with the state’s tradition of generous public assistance and philosophical commitment to healthcare as fundamental need rather than earned benefit. The Minnesota Department of Human Services webinar in August 2025 walked navigators and community partners through Medicaid provisions in H.R.1: at least 320,000 Minnesotans would likely be subject to work reporting requirement rules, approximately 23 percent of the state’s Medicaid population. Governor Tim Walz marked the 60th anniversary of Medicaid and Medicare in July 2025 by highlighting impacts of federal cuts. State officials projected that federal Medicaid changes would cost Minnesota $1.4 billion in federal funding over four years, with losses deepening over time to potentially $2.5 billion per biennium. Now federal law compels compliance, forcing the Walz administration to reconcile DFL values with federal mandates.

MRWR-14MO: Missouri

Sun, 15 Feb 2026 00:00:00 +0000

The hearing room in the Missouri Capitol was tense on January 16, 2026. State Representative Darin Chappell of Rogersville had come to the House Legislative Review Committee with a proposal that would have seemed redundant just months earlier: a constitutional amendment to enshrine Medicaid work requirements in Missouri’s foundational law, mirroring requirements that H.R.1 already mandated. The irony was thick. Missouri voters had amended the same constitution in 2020 to expand Medicaid and explicitly prohibit “greater or additional burdens on eligibility or enrollment standards” for expansion adults. Now Republicans wanted to amend the constitution again, this time to make work requirements permanent even if federal law changed. “The reality of it is this is coming to Missouri, irrespective of this,” Chappell told the committee. “This is just saying we should keep it that way.”

Summary: MRWR-14MO: Missouri

Sun, 15 Feb 2026 00:00:00 +0000

Missouri confronts work requirement implementation with a unique combination of voter-approved constitutional protections, documented administrative dysfunction, and a legislature determined to use federal mandates to override both. Approximately 327,000 to 355,000 expansion adults face 80-hour monthly work requirements beginning December 2026, but the state’s defining challenge is not philosophical opposition to the policy. It is operational incapacity to execute requirements that demand processing proof of qualifying activity for hundreds of thousands of enrollees while conducting eligibility checks twice per year on technology systems that predate modern verification requirements.

Article 14.MS: Mississippi

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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. She earns approximately $11,000 annually. She has diabetes that remains untreated because she cannot afford insulin or doctor visits. She has no dependent children. She earns too much for Mississippi Medicaid, which caps parent eligibility at 24% of the federal poverty level and categorically excludes childless adults. She earns too little for marketplace premium subsidies, which begin at 100% of poverty. She represents one of approximately 70,000 Mississippians in the coverage gap: the deepest poverty in the nation, yet excluded from coverage because the state chose not to expand Medicaid.

Summary: Article 14.MS: Mississippi

Sun, 15 Feb 2026 00:00:00 +0000

Mississippi maintains the deepest poverty nationally yet remains among ten states declining Medicaid expansion, leaving approximately 70,000 adults in the coverage gap. The state came closest to expansion in 2024 when House Bill 1725 passed the Mississippi House 98-20 (veto-proof supermajority), directing the Division of Medicaid to seek federal waiver for expansion with 20-hour weekly work requirements. The House bill included fallback provision: if CMS rejected work requirements, expansion would proceed without them from January 2025 through early 2029. The Senate amended to expand coverage only to 100% FPL (not 138% required for enhanced federal matching) and made expansion entirely contingent on federal work requirement approval. House and Senate could not reconcile differences in conference committee; the bill died. Federal work requirements under H.R. 1 do not apply because Mississippi has no expansion population. The state demonstrates the work requirement paradox: Republican leadership demanded work requirements as expansion precondition for years, H.R. 1 now mandates requirements federally, financial incentives have been eliminated, yet Mississippi still refuses expansion.

Article 14.MT: Montana

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Medicaid Work Requirements

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 nearest urgent care clinic might be two counties away. Along this stretch, a handful of Medicaid expansion enrollees work seasonal jobs on cattle ranches, in grain processing, and at the handful of small businesses that keep communities like Miles City and Jordan functioning. Most of them already meet the 80 hours monthly that federal law will soon require. Their challenge is not finding work. It is proving, to a verification system designed for urban labor markets, that the work they do counts.

Article 14.NC: North Carolina

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

Word Count Target: 2,500-3,000 words

State Profile
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Demographics

Expansion adult population: approximately 650,000-680,000 (as of late 2025)
North Carolina was the 40th state to expand Medicaid (December 1, 2023)
Age distribution: 19-29 (approximately 35-40%), 30-49 (approximately 35%), 50-64 (approximately 25%)
Gender composition: approximately 56% female, 44% male
Racial and ethnic composition: approximately 57% white, 37% Black, 10% Hispanic/Latino
Black enrollment concentrated in eastern North Carolina and urban centers (Charlotte, Raleigh-Durham)
Approximately 73% of expansion enrollees were already working when they enrolled
Total Medicaid enrollment exceeds 3 million (approximately 1 in 4 North Carolinians)

Geographic Characteristics

Summary: Article 14.NC: North Carolina

Sun, 15 Feb 2026 00:00:00 +0000

North Carolina’s defining characteristic for work requirement implementation is time compression. The state expanded Medicaid in December 2023, barely two years before federal requirements take effect. Unlike states that expanded in 2014 and spent a decade stabilizing enrollment, North Carolina must simultaneously mature its expansion program and build work requirement infrastructure with 10 months from OBBBA’s passage to launch verification systems and communicate requirements to 650,000+ expansion adults.

Senate Bill 403, passed 34-12 in April 2025, directed NCDHHS to implement any CMS-approved work requirements. Sponsors framed legislation as protective, signaling federal alignment. Critics noted 60% of expansion enrollees already work, while the remaining 40% are disabled, too ill to work, attend school, or serve as caregivers. NCDHHS warned 255,000 North Carolinians could lose coverage, with 83% having gained coverage only through recent expansion.

Article 14.ND: North Dakota

Sun, 15 Feb 2026 00:00:00 +0000

Williams County produces more than 500,000 barrels of oil daily from the Bakken Formation, creating employment patterns that defy traditional verification assumptions. Contract workers cycle through months of 80-hour weeks followed by gaps when contracts end or prices decline. Temporary housing arrangements shift with work locations. Documentation comes from staffing agencies rather than direct employers. The oil economy that drives North Dakota’s exceptionally low unemployment rate simultaneously creates verification challenges that a state with 23,000 affected expansion adults must solve without the administrative infrastructure that larger states possess.

Article 14.NE: Nebraska

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 Bill Act. Enforcement would begin May 1, 2026, seven months ahead of the federal deadline. By January 1, 2026, the state would begin notifying approximately 70,000 Heritage Health expansion adults through mail, phone, and text that new requirements were coming. Nebraska chose to implement through a state plan amendment rather than a Section 1115 waiver, bypassing the public comment periods and CMS negotiation that the waiver process requires.

Article 14.NH: New Hampshire

Sun, 15 Feb 2026 00:00:00 +0000

New Hampshire’s compact geography creates a distinctive implementation landscape. The southern tier, anchored by Manchester and Nashua, contains the majority of the state’s 60,000 expansion adults, with most living within 60 minutes of major service centers. This concentration provides an administrative advantage compared to larger rural states. However, the North Country presents a stark contrast. Coos County has only 20 people per square mile compared to 775 per square mile in the southern tier, where geographic isolation compounds documentation challenges. The state that learned its systems weren’t ready in 2019 now has until January 2027 to ensure they’re ready again, though the federal timeline is fundamentally different than the state-driven attempt six years earlier.

Summary: Article 14.NH: New Hampshire

Sun, 15 Feb 2026 00:00:00 +0000

New Hampshire attempted work requirements in 2019, failed catastrophically before enforcement could begin, and now faces a federal mandate requiring the same policy by January 2027. In July 2019, only about 8,100 of approximately 25,000 expansion adults had successfully documented compliance. Nearly 17,000 residents faced potential coverage loss, not because they weren’t working but because they couldn’t prove it through verification systems. Governor Chris Sununu extended the compliance deadline to September 30, 2019, acknowledging large numbers who hadn’t reported reflected system failures rather than actual non-compliance. A federal district court struck down CMS approval before enforcement proceeded, finding CMS failed to consider predictable coverage losses. H.R. 1 transforms work requirements from state-option experiment into federal mandate affecting approximately 60,000 expansion adults. Current projections suggest 17,000 to 19,000 coverage losses, consistent with 2019 experience before implementation was halted.

MRWR-14NJ: New Jersey

Sun, 15 Feb 2026 00:00:00 +0000

Summary: MRWR-14NJ: New Jersey

Sun, 15 Feb 2026 00:00:00 +0000

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 for the Garden State: up to 300,000 New Jerseyans could lose Medicaid coverage or fail to obtain it due to “bureaucratic barriers” created by H.R.1, with approximately 50,000 losing coverage specifically because of work requirement documentation failures. The distinction mattered. Adelman was not arguing that 300,000 people would fail to work. She was arguing that the administrative machinery of compliance would overwhelm a population that, by and large, already did. Seventy-one percent of New Jersey’s Medicaid expansion adults were already employed: 43 percent working full-time and 28 percent working part-time. These were home health aides in Bergen County, warehouse workers along the Turnpike corridor, restaurant staff in the Shore towns, childcare workers in Camden. They worked. They just did not carry the documentation that a federal compliance system would demand.

New Mexico: Work Requirements in the Land of Provider Scarcity

Sun, 15 Feb 2026 00:00:00 +0000

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. She earns enough to maintain Centennial Care coverage under current rules but not quite enough to afford marketplace insurance. Her employer operates with minimal margins, unable to offer health benefits or guarantee 40-hour weeks. Starting January 2027, Rosa will need to document 80 hours monthly of work or other qualifying activities to maintain her Medicaid coverage. Her documented work hours will fall short unless she can combine employment with job training or education, activities difficult to access in a rural community where the nearest community college is 45 minutes away and evening classes conflict with her work schedule.

Summary: New Mexico: Work Requirements in the Land of Provider Scarcity

Sun, 15 Feb 2026 00:00:00 +0000

New Mexico implements Medicaid work requirements facing challenges unlike almost any other state. Twenty-three federally recognized tribes and pueblos create extraordinary administrative complexity. Thirty-two of the state’s 33 counties are designated wholly or partially as health professional shortage areas. Six to eight rural hospitals face closure risk from federal Medicaid cuts independent of work requirement coverage losses. The state projects losing $1.4 billion in federal funding over four years deepening to $2.5 billion per biennium, yet must build verification infrastructure for approximately 120,000 expansion adults while provider networks struggle to deliver care to those who maintain coverage. Governor Michelle Lujan Grisham’s administration has warned openly that H.R.1 provisions will cause harm to New Mexicans.

Article 14.NV: Nevada

Sun, 15 Feb 2026 00:00:00 +0000

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 challenge. Casino dealers work swing shifts that rotate weekly. Hotel housekeepers piece together hours across multiple properties during convention seasons, then face reduced schedules during slow periods. Restaurant servers depend on tip income that fluctuates dramatically based on tourist volumes. These employment patterns, perfectly normal in Nevada’s economy, are precisely the kinds that verification systems struggle to document.

Summary: Article 14.NV: Nevada

Sun, 15 Feb 2026 00:00:00 +0000

Nevada’s 313,000 expansion adults face work requirements designed for stable employment in an economy defined by variable schedules, tip-based income, and seasonal tourist volumes. Las Vegas employs more than 300,000 people in leisure and hospitality, the sector that creates Nevada’s distinctive implementation challenge. Casino dealers work swing shifts that rotate weekly. Hotel housekeepers piece together hours across multiple properties during convention seasons, then face reduced schedules during slow periods. Restaurant servers depend on tip income that fluctuates dramatically based on tourist volumes. These employment patterns, perfectly normal in Nevada’s economy, are precisely the kinds that verification systems struggle to document.

Article 14.NY: New York

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 just one front of a two-front war. H.R. 1 had eliminated $7.5 billion in annual federal funding for New York’s Essential Plan while simultaneously imposing work requirements on more than two million expansion adults. The state that had built the nation’s most generous coverage architecture was now watching it fracture under a single piece of legislation. For New York, the question was never whether to resist. The question was how much damage control was possible when the federal government rewrites the rules for a state serving more Medicaid enrollees than most countries serve citizens.

Summary: Article 14.NY: New York

Sun, 15 Feb 2026 00:00:00 +0000

New York faces Medicaid work requirements under conditions no other state approaches: approximately 2.1 million expansion adults representing the second largest concentration nationally, simultaneous Essential Plan collapse eliminating coverage for 450,000 additional New Yorkers, administration fragmented across 58 different local departments, and provider financing architecture constrained by H.R.1’s provider tax freeze. When Governor Kathy Hochul announced on September 10, 2025 that the state had no choice but to terminate its Essential Plan expansion, she was describing one front of a two-front war that will test whether work requirements can be implemented at genuine scale without catastrophic coverage losses.

Article 14.OH: Ohio

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 Medicaid work requirements. Patrick Beatty, the department’s Deputy Director and Chief Policy Officer, walked through a framework built around a simple insight that Ohio had arrived at years earlier: with nearly 770,000 expansion adults, the state cannot process individual compliance determinations through human review. The math does not allow it. Whatever Ohio builds must be automated first and manual second, or it will not work at all.

Summary: Article 14.OH: Ohio

Sun, 15 Feb 2026 00:00:00 +0000

Ohio Department of Medicaid hosted webinars in November 2025 offering the most detailed picture yet of how any large state plans to operationalize Medicaid work requirements. Deputy Director Patrick Beatty walked through a framework built around a fundamental insight: with nearly 770,000 expansion adults, the state cannot process individual compliance determinations through human review. Whatever Ohio builds must be automated first and manual second, or it will not work at all. Ohio reached this conclusion during design of its 2019 Section 1115 waiver proposing community engagement requirements verified primarily through administrative data matching. That waiver was approved during the first Trump administration but never implemented because COVID-19 intervened and the Biden administration later withdrew approval. ODM submitted a new waiver application to CMS on February 28, 2025. Then the One Big Beautiful Bill Act signed July 4, 2025, established a nationwide requirement covering all nonexempt expansion adults ages 19 through 64, requiring 80 hours monthly, imposing semi-annual redeterminations, and setting a hard January 1, 2027 implementation deadline.

MRWR-14OK: Oklahoma

Sun, 15 Feb 2026 00:00:00 +0000

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 captured six years of frustration. “Government dependency is a trap,” he said. “It robs self-reliance and balloons budgets. I always say government programs should be a trampoline, not a hammock, but too often that is not the case. Medicaid is Exhibit A, driving massive spending growth while enabling waste.” Stitt then called on lawmakers to send a question to voters that would “allow adjustments” to Medicaid expansion, the same program Oklahoma voters had enshrined in the state constitution just five years earlier specifically to prevent him from doing what he was now asking to do.

Summary: MRWR-14OK: Oklahoma

Sun, 15 Feb 2026 00:00:00 +0000

Oklahoma became the first state to expand Medicaid through constitutional amendment when voters approved State Question 802 on June 30, 2020, by 50.45 percent. The initiative’s drafters had studied Maine, Nebraska, Idaho, and Utah, where governors and legislatures attempted to undermine voter-approved expansions by attaching work requirements, premiums, and other restrictions. They chose constitutional language requiring another statewide referendum to modify: “No greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance under Oklahoma’s Medicaid program.” That provision was aimed directly at Governor Kevin Stitt’s SoonerCare 2.0 proposal, which would have implemented partial expansion with community engagement requirements. Voters foreclosed that path.

Oregon: CCO Infrastructure Meets Federal Compliance

Sun, 15 Feb 2026 00:00:00 +0000

The Oregon Health Authority quietly updated its public-facing information in late 2025. The message was straightforward: starting in 2027, some adults will need to meet work or other activity requirements to qualify for the Oregon Health Plan. There was nothing members needed to do now. This change would apply to new applications or renewals beginning in 2027. The careful framing reflected Oregon’s pragmatic approach. The state would comply with federal mandates while building systems designed to maintain coverage rather than enforce penalties.

Summary: Oregon: CCO Infrastructure Meets Federal Compliance

Sun, 15 Feb 2026 00:00:00 +0000

Oregon approaches work requirement implementation with distinctive coordinated care organization infrastructure that provides member engagement capacity most states lack but creates tensions between clinical mission and compliance monitoring. Governor Tina Kotek’s administration faces the challenge of overlaying work verification onto systems designed for care coordination, not compliance enforcement. The Oregon Health Authority quietly updated public-facing information in late 2025 with careful framing: starting in 2027, some adults will need to meet work or other activity requirements. There was nothing members needed to do now. The pragmatic approach reflects state commitment to build systems designed to maintain coverage rather than enforce penalties.

Article 14.PA: Pennsylvania

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

Governor Josh Shapiro did not mince words. Pennsylvania, he said after H.R. 1 was signed on July 4, 2025, “got screwed.” The law would cause approximately 310,000 Pennsylvanians to lose Medicaid coverage, he warned, while 25 rural hospitals already operating with deficits faced potential closure from the cascading financial effects. His administration’s 2025-26 budget explicitly “resisted efforts to kick people off Medicaid.” But resistance in a Democratic governor’s mansion meets its limits when the federal government imposes a mandate, and those limits are where Pennsylvania’s real implementation story begins.

Summary: Article 14.PA: Pennsylvania

Sun, 15 Feb 2026 00:00:00 +0000

Governor Josh Shapiro did not mince words. Pennsylvania, he said after H.R.1 was signed on July 4, 2025, “got screwed.” The law would cause approximately 310,000 Pennsylvanians to lose Medicaid coverage, he warned, while 25 rural hospitals already operating with deficits faced potential closure from cascading financial effects. His administration’s 2025-26 budget explicitly “resisted efforts to kick people off Medicaid.” But resistance in a Democratic governor’s mansion meets its limits when the federal government imposes a mandate, and those limits are where Pennsylvania’s real implementation story begins.

Rhode Island: Small State, Outsized Implementation Challenges

Sun, 15 Feb 2026 00:00:00 +0000

Maria Silva works 70 hours monthly between two jobs in Providence, one cleaning houses and another doing food preparation at a catering company. Neither job offers consistent scheduling or health benefits. She enrolled in Rhode Island Medicaid when the state embraced expansion in 2014 under then-Governor Lincoln Chafee. Maria speaks limited English and relies on her daughter to help navigate healthcare paperwork. Starting January 2027, she will need to document her work hours across multiple employers or find additional qualifying activities to reach the 80-hour monthly requirement. SNAP work requirements implemented in March 2025 already require her to track activities for food assistance. Now she must manage parallel verification for health coverage, doubling administrative burden for someone working multiple jobs while managing household responsibilities.

Summary: Rhode Island: Small State, Outsized Implementation Challenges

Sun, 15 Feb 2026 00:00:00 +0000

Rhode Island approaches work requirement implementation as the smallest expansion state after Vermont, with compact geography but complex demographic composition. Approximately 85,000 expansion adults face 80-hour monthly requirements beginning December 2026, but the state’s defining challenge is not population size. It is the multilingual population concentrated in core cities, strong managed care infrastructure now disrupted by contract cancellation, and Governor Dan McKee’s projection that 24,500 Rhode Islanders are at risk of losing coverage due to verification barriers. The number matters because it reflects realistic assessment of documentation failures rather than policy enthusiasm. Rhode Island did not choose work requirements. The state must implement federal mandates while managing concurrent challenges from immigration eligibility restrictions, healthcare system capacity constraints, and managed care infrastructure uncertainty.

Article 14.SC: South Carolina

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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 Engagement Initiative. The letter was careful in its framing, describing the initiative as a mechanism to “strengthen the Medicaid program’s dual missions of financing health services and improving opportunities for independence, self-reliance, and prosperity.” What McMaster was asking for, stripped of its careful language, was permission to offer limited Medicaid coverage to some of the roughly 150,000 to 180,000 South Carolinians trapped in the coverage gap, but only if they could prove they were working 80 hours a month. South Carolina would extend healthcare to people who currently have none, but only to those who could document that they deserved it.

Summary: Article 14.SC: South Carolina

Sun, 15 Feb 2026 00:00:00 +0000

South Carolina is the only state voluntarily pursuing work requirements for a population it is not required to cover. Governor Henry McMaster requested reinstatement of work requirement authority in January 2025. The Department of Health and Human Services submitted the Palmetto Pathways to Independence waiver in June 2025. The timing was notable: submission arrived during congressional negotiations over the One Big Beautiful Bill Act, signed eleven days later. But OBBBA’s work requirements, which apply to Medicaid expansion adults, do not apply to South Carolina. The state has never expanded Medicaid. It is one of ten states that declined to extend coverage to all adults up to 138 percent of the federal poverty level. South Carolina’s waiver pursuit is voluntary, an independent policy choice layered on top of, rather than compelled by, the federal mandate.

MRWR-14SD: South Dakota

Sun, 15 Feb 2026 00:00:00 +0000

The Department of Social Services conference room in Pierre was nearly empty when Secretary Matt Althoff announced the obvious in July 2025. South Dakota’s carefully crafted SDCareerLink waiver proposal, released for public comment just weeks earlier, was now “an exercise in futility.” The federal work requirements signed into law July 4 had rendered the state’s independent approach moot. South Dakota had spent months developing a deliberately modest verification system, annual attestation without monthly hour tracking, qualitative participation standards instead of quantitative thresholds. The state wanted work requirements but not the administrative apparatus to enforce them. H.R.1 mandated precisely what South Dakota sought to avoid: 80 hours monthly, semi-annual redeterminations, upfront compliance verification before enrollment begins.

Summary: MRWR-14SD: South Dakota

Sun, 15 Feb 2026 00:00:00 +0000

The Department of Social Services conference room in Pierre was nearly empty when Secretary Matt Althoff announced the obvious in July 2025. South Dakota’s SDCareerLink waiver proposal was now “an exercise in futility.” Federal work requirements signed July 4 had rendered the state’s independent approach moot. South Dakota had developed deliberately modest verification: annual attestation without monthly hour tracking, qualitative participation standards. The state wanted work requirements but not the administrative apparatus to enforce them. OBBBA mandated precisely what South Dakota sought to avoid: 80 hours monthly, semi-annual redeterminations, upfront compliance verification.

Article 14.TN: Tennessee

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

A 35-year-old mother in rural Appalachian Tennessee works part-time at a local retail store earning approximately $9,500 annually. She has two school-age children. She qualifies for TennCare because Tennessee increased parent eligibility to 100% of the federal poverty level in 2024, making it the highest threshold among non-expansion states. Her children receive TennCare Standard coverage. If Tennessee implements the TennCare III block grant waiver proposal with work requirements for traditional populations, she would need to document 80 hours monthly of work, training, or qualifying activities despite already working. Her sister, also working part-time but childless and earning $11,000 annually, has no coverage option. She falls into Tennessee’s coverage gap: too poor for marketplace subsidies, categorically excluded from Medicaid because Tennessee never expanded under the ACA. The sisters represent Tennessee’s paradox: aggressive pursuit of work requirements for populations that have coverage while maintaining categorical exclusion for the working poor without it.

Article 14.TX: Texas

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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. He has no dependent children. He works 35 hours per week during busy seasons, less when construction slows. He has diabetes but cannot afford insulin. He is categorically ineligible for Texas Medicaid. He earns too little to qualify for marketplace premium subsidies, which begin at 100% of poverty. He exists in the coverage gap: too poor for subsidized insurance, too healthy for disability Medicaid, too childless for parent Medicaid, simply too Texan for coverage.

Summary: Article 14.TX: Texas

Sun, 15 Feb 2026 00:00:00 +0000

Texas maintains the largest coverage gap nationally, with 617,000 to 726,000 adults (40-45% of the entire national coverage gap) earning too little for marketplace subsidies but excluded from Medicaid because Texas never expanded under the ACA. Federal work requirements under H.R. 1 do not apply because Texas has no expansion population. The state’s traditional Medicaid program serves approximately 4.4 million individuals, predominantly children, elderly, and disabled populations, through one of the most restrictive eligibility structures nationally. Parent eligibility caps at 14-17% FPL (approximately $4,100 annually for a family of three), tied with Alabama as the strictest nationally. A parent working half-time at minimum wage earns too much to qualify. Childless adults face complete categorical exclusion regardless of income. Texas has the highest uninsured rate nationally (16.7% overall, 21.6% among working-age adults) and persistently rejected expansion through 11 years of Republican legislative supermajorities. The state demonstrates how non-expansion status creates worse outcomes than work requirements: complete exclusion from coverage regardless of work, volunteer, or qualifying activities.

Article 14.UT: Utah

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Medicaid Work Requirements

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 Aramina, who is five years old and lives with Apert syndrome. Medicaid paid for the hand surgery that gave Aramina functional use of her fingers. Aramina wants to become a veterinarian. Garcia did not testify about work requirements in the abstract. She testified about what happens when bureaucratic conditions separate children and families from the coverage that makes surgery possible, therapy accessible, and futures imaginable.

Summary: Article 14.UT: Utah

Sun, 15 Feb 2026 00:00:00 +0000

On May 14, 2025, Angie Garcia told a Utah DHHS public hearing about her daughter Aramina, who is five and lives with Apert syndrome. Medicaid paid for hand surgery giving Aramina functional use of her fingers. Garcia testified about what happens when bureaucratic conditions separate families from coverage making surgery possible. What none of the speakers could have known was that within weeks, a provision buried in OBBBA would transform Utah’s work requirement debate into existential fiscal crisis. The law’s FMAP penalty for states covering noncitizens through State CHIP would collide with a Utah trigger statute forcing state leaders to choose between healthcare for 2,000 immigrant children and 75,000 expansion adults. Dr. William Cosgrove, writing in Deseret News, named the dilemma precisely: Utah’s legislature now faces “Sophie’s choice.”

MRWR-14VA: Virginia

Sun, 15 Feb 2026 00:00:00 +0000

Abigail Spanberger took the oath of office as Virginia’s 74th governor on January 17, 2026, becoming the first woman to lead the Commonwealth. Within hours, she signed Executive Order One, establishing the Economic Resiliency Task Force charged with implementing “changes to Medicaid and SNAP resulting from H.R. 1 while protecting access for eligible Virginians.” The careful phrasing captured the posture of a state that did not want work requirements but recognized they were coming regardless. Spanberger’s order also created an Interagency Health Financing Task Force to maximize federal funding during the transition, a tacit acknowledgment that Virginia’s fiscal exposure extended well beyond the compliance challenge itself.

Summary: MRWR-14VA: Virginia

Sun, 15 Feb 2026 00:00:00 +0000

Abigail Spanberger took the oath of office as Virginia’s 74th governor on January 17, 2026, becoming the first woman to lead the Commonwealth. Within hours, she signed Executive Order One establishing the Economic Resiliency Task Force charged with implementing “changes to Medicaid and SNAP resulting from H.R.1 while protecting access for eligible Virginians.” The careful phrasing captured the posture of a state that did not want work requirements but recognized they were coming regardless. The November 2025 elections gave Democrats a sweep of statewide offices and expanded legislative majorities. The political context could not have been more favorable for resisting work requirements. But H.R.1 left no room for resistance. Virginia could choose how to implement, but not whether.

Vermont: Rural State Faces Urban-Designed Requirements

Sun, 15 Feb 2026 00:00:00 +0000

Michael Thompson lives in Caledonia County in Vermont’s Northeast Kingdom, working seasonally at a ski resort and doing construction when weather permits. Between both activities he averages 70 hours monthly during winter and fall but struggles during mud season when construction halts and tourist activity drops. He enrolled in Green Mountain Care when Vermont implemented Medicaid expansion in 2014. Starting January 2027, Michael will need to document 80 hours monthly of qualifying activities to maintain coverage. The nearest community college offering job training programs is 45 minutes away. His volunteer fire department service does not generate hour documentation. Whether seasonal income averaging provisions will accommodate Northeast Kingdom employment realities remains uncertain.

Summary: Vermont: Rural State Faces Urban-Designed Requirements

Sun, 15 Feb 2026 00:00:00 +0000

Vermont approaches work requirement implementation as the smallest expansion state facing geographic isolation, healthcare system fragility, and unprecedented organizational transition. Approximately 35,000 to 55,000 expansion adults face 80-hour monthly requirements beginning December 2026, but the state’s defining challenge is not population size. It is the Northeast Kingdom’s seasonal employment patterns, OneCare Vermont’s wind-down at the end of 2025, fee-for-service managed care model operated directly by the Department of Vermont Health Access rather than through commercial MCOs, and a rural healthcare system where thirteen of fourteen hospitals receive Medicaid disproportionate share payments and eight are designated Critical Access Hospitals operating at financial margins.

Washington: Apple Health Meets Federal Mandate

Sun, 15 Feb 2026 00:00:00 +0000

In July 2025, the Washington State Senate Health and Long-Term Care Committee convened to discuss the implications of H.R. 1 for Medicaid. Medicaid Director Fotinos delivered the stark assessment: work requirements would affect 620,000 adults enrolled in Apple Health, and while most recipients already work, the administrative burden would drive significant coverage losses. The Health Care Authority was working to automate eligibility through CMS systems, but those systems wouldn’t be ready until June 2027. Fortunately, Washington already qualified to delay implementation of federal work requirements until December 2028 by demonstrating good faith effort toward compliance infrastructure.

Summary: Washington: Apple Health Meets Federal Mandate

Sun, 15 Feb 2026 00:00:00 +0000

Washington implements Medicaid work requirements from a defensive posture, having already secured a good-faith extension delaying enforcement until late 2028 at the earliest. Governor Bob Ferguson, who took office in January 2025 after serving as attorney general, has been among the most vocal critics of federal Medicaid changes, predicting at least 250,000 Washingtonians would lose coverage. The state’s approximately 620,000 expansion adults enrolled in Apple Health face requirements the state legislature never authorized and the governor’s office actively opposes, creating implementation dynamics where resistance becomes harm reduction.

MRWR-14WI: Wisconsin

Sun, 15 Feb 2026 00:00:00 +0000

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 act (known as the ‘One Big Beautiful Bill Act’) passed July 4, 2025, included provisions that directly affect Wisconsin’s Medicaid and FoodShare programs.” Below it, a link to Governor Tony Evers’ impact analysis delivers the numbers in blunter terms. DHS estimates that 63,000 Wisconsinites are at high risk of losing coverage due to work requirements alone. The administrative cost to implement them: $74.2 million annually in new systems, staffing, and training. The expected return on that investment in workforce participation: effectively zero, based on Congressional Budget Office findings that Medicaid work requirements do not meaningfully increase employment.

Summary: MRWR-14WI: Wisconsin

Sun, 15 Feb 2026 00:00:00 +0000

Wisconsin occupies a unique position among work requirement states. It never expanded Medicaid under the ACA, yet covers childless adults to 100 percent FPL through Section 1115 waiver authority. It received federal work requirement approval in 2018 but never implemented. Its Democratic governor has proposed Medicaid expansion in every budget since 2019; its Republican legislature has rejected expansion every time. Now H.R.1 requires building compliance infrastructure for a population earning below poverty, at a cost that full expansion would have rendered unnecessary, while $1.6 billion in enhanced federal matching funds sits unclaimed. Wisconsin will spend tens of millions verifying whether its poorest residents work enough hours to deserve healthcare while declining federal funds that would extend coverage to residents earning 38 percent more.

West Virginia: Work Requirements in the Nation's Disability Capital

Sun, 15 Feb 2026 00:00:00 +0000

Governor Patrick Morrisey stood before West Virginia’s legislature in January 2026, outlining his vision for the state’s future. Amid discussions of income tax cuts, data centers, and foster care reform, he addressed Medicaid work requirements with characteristic directness. The federal mandate, he told lawmakers, represented “good and necessary reform so that Medicaid is being used for temporary assistance and not a permanent entitlement.” Work requirements on SNAP and Medicaid, he suggested, would help with the state’s health outcomes.

Article 14.WY: Wyoming

Sun, 15 Feb 2026 00:00:00 +0000

Series 14: State Implementation of Work Requirements

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. During winter months he has no employment. He has no dependent children. He has diabetes that requires monitoring and medication. He has no employer-sponsored health insurance. He earns too much for Wyoming Medicaid during work months, which caps parent eligibility at approximately 56% of the federal poverty level and excludes childless adults entirely. He earns too little during winter months to qualify for marketplace subsidies, which begin at 100% FPL annualized. He represents one of approximately 9,000 Wyomingites in the coverage gap: working poor in the nation’s least populous state, with the second-lowest population density, excluded from coverage because Wyoming chose not to expand Medicaid. The nearest hospital is 87 miles away.

Summary: Article 14.WY: Wyoming

Sun, 15 Feb 2026 00:00:00 +0000

Wyoming represents the limiting case for Medicaid work requirements: the smallest projected expansion population (approximately 19,000 enrollees), the most extreme frontier geography, the second-lowest population density nationally after Alaska, and persistent legislative resistance to expansion spanning over a decade. The state never expanded Medicaid under the ACA, leaving approximately 9,000 residents in the coverage gap with no affordable coverage option. Federal work requirements under H.R. 1 do not apply because Wyoming has no expansion population. The state submitted an application for up to $800 million from the federal Rural Health Transformation Program in November 2025, seeking to address rural healthcare infrastructure through alternative federal funding rather than Medicaid expansion. Wyoming demonstrates how state political culture can permanently override federal policy incentives, maintaining coverage gaps regardless of hospital advocacy, public need, or federal funding availability. If Wyoming ever expands, the combination of frontier geography and complete lack of managed care infrastructure would create implementation challenges requiring unprecedented federal flexibility.

MRWR-14Group1SYN: When Experience Becomes Burden

Sun, 15 Feb 2026 00:00:00 +0000

In September 2018, Arkansas terminated Sarah Martinez’s Medicaid coverage. She worked 35 hours weekly as a nursing home aide in Little Rock, earning $11.50 an hour caring for elderly patients. The state required monthly online reporting to maintain coverage. She had no home computer. The nursing home’s shared staff terminal crashed frequently. The public library closed before her evening shift ended. Over three months she tried to report her hours. Portal timeouts. Password reset failures. System errors. Arkansas saw non-compliance. Federal courts later saw documentation failure among working people. Martinez was one of 18,164 Arkansans who lost coverage in ten months, most of them working or exempt but unable to navigate verification systems designed to catch non-workers.

MRWR-14Group2SYN: The Competence Paradox

Sun, 15 Feb 2026 00:00:00 +0000

In November 2025, seventeen Massachusetts ACO executives gathered in a Boston conference room to discuss work requirement implementation. Their organizations served 800,000 MassHealth members through sophisticated care management platforms with two-sided risk arrangements and quality incentive payments. They had data infrastructure connecting primary care, behavioral health, social services, and community organizations. They measured clinical outcomes, tracked social determinants, coordinated complex care. One executive asked the obvious question: how do we layer employment verification onto systems designed to improve health outcomes, not police work status? The room went quiet. They had the technical capacity. What they lacked was belief that the policy served their members’ interests.

MRWR-14Group3SYN: The States Where Requirements Don't Apply

Sun, 15 Feb 2026 00:00:00 +0000

Maria Rodriguez works 35 hours weekly at a Houston grocery store earning $14,800 annually, about 38% of federal poverty level for her family of three. Under Texas Medicaid rules she qualifies for coverage as a parent. Her coworker earning $16,000 annually does not qualify, falls into Texas’s coverage gap, and has no insurance despite working full-time. When H.R.1 passed in July 2025 mandating work requirements for Medicaid expansion adults, neither Maria nor her coworker faced those requirements. Texas never expanded Medicaid. The federal mandate applies only to expansion populations these states do not have.

MRWR-14Group4SYN: When Geography Becomes Impossibility

Sun, 15 Feb 2026 00:00:00 +0000

Tom lives twelve miles outside Havre, Montana where the phone company deemed broadband infrastructure economically unviable. No internet reaches his property. Cell service works sporadically, dropping calls and refusing to load web pages. The nearest public computer sits in a library 75 miles away, open Monday through Friday until 5 PM when he works at the feed store 45 minutes from home. When Montana’s work requirement verification system launched in December 2026 requiring online monthly reporting, Tom had no way to comply. He works 40 hours weekly. The system cannot see his work because the infrastructure to verify does not exist where he lives.

MRWR-14Group5SYN: When the Jobs Left and Never Came Back

Sun, 15 Feb 2026 00:00:00 +0000

Debra worked 28 years on the floor of a Detroit auto parts supplier before the plant closed in 2009. She is 56 years old with chronic back pain from standing at assembly lines, carpal tunnel from repetitive motion, and hearing damage from factory noise. These conditions prevent returning to manufacturing work but do not meet Social Security disability criteria. She works 15 hours weekly at a convenience store, the only employer within walking distance of her eastside neighborhood. She needs 80 hours monthly to keep Medicaid. The math does not work. There are no other jobs reachable without a car she cannot afford. She is not refusing to work more. There is no more work to refuse.

MRWR-14Group6SYN: When Categories Fail

Sun, 15 Feb 2026 00:00:00 +0000

Maria moved to Las Vegas from rural Mexico in 2019, working as a housekeeper at a Strip casino. She enrolled in Nevada Medicaid when the state expanded in 2020. Her work is steady but her hours fluctuate. During convention season she works 50 hours weekly. During slow periods she drops to 25. The casino schedules her across three different properties depending on occupancy. Her paystubs come from different employer ID numbers. She speaks limited English. The verification portal assumes stable employment with single employer generating consistent documentation. Her employment reality fits none of these assumptions.

State Implementation Profiles on Syam Adusumilli

Alaska: Work Requirements in America's Last Frontier

Summary: Alaska: Work Requirements in America's Last Frontier

Article 14.AL: Alabama

Summary: Article 14.AL: Alabama

Article 14.AR: Arkansas

Summary: Article 14.AR: Arkansas

Article 14.AZ: Arizona

Summary: Article 14.AZ: Arizona

Article 14.CA: California

Summary: Article 14.CA: California

Colorado: County Administration Meets Federal Timeline

Summary: Colorado: County Administration Meets Federal Timeline

Connecticut: Work Requirements Meet Fee-for-Service Medicaid

District of Columbia: The Federal Territory Faces Federal Mandates

Article 14.DE: Delaware

Summary: Article 14.DE: Delaware

Article 14.FL: Florida

Summary: Article 14.FL: Florida

Article 14.GA: Georgia

Summary: Article 14.GA: Georgia

Hawaii: Work Requirements Across the Pacific

Article 14.IA: Iowa

Summary: Article 14.IA: Iowa

MRWR-14ID: Idaho

Summary: MRWR-14ID: Idaho

Article 14.IL: Illinois

Summary: Article 14.IL: Illinois

Article 14.IN: Indiana

Summary: Article 14.IN: Indiana

Article 14.KS: Kansas

Summary: Article 14.KS: Kansas

Article 14.KY: Kentucky

Summary: Article 14.KY: Kentucky

MRWR-14LA: Louisiana

Summary: MRWR-14LA: Louisiana

Massachusetts: When Healthcare Reform Meets Work Requirements

Summary: Massachusetts: When Healthcare Reform Meets Work Requirements

Maryland: Work Requirements Meet Healthcare System Transformation

Summary: Maryland: Work Requirements Meet Healthcare System Transformation

Maine: From Referendum Victory to Federal Mandate

Article 14.MI: Michigan

Summary: Article 14.MI: Michigan

Minnesota: DFL Principles Meet Federal Reality

Summary: Minnesota: DFL Principles Meet Federal Reality

MRWR-14MO: Missouri

Summary: MRWR-14MO: Missouri

Article 14.MS: Mississippi

Summary: Article 14.MS: Mississippi

Article 14.MT: Montana

Article 14.NC: North Carolina

State Profile #

Summary: Article 14.NC: North Carolina

Article 14.ND: North Dakota

Article 14.NE: Nebraska

Article 14.NH: New Hampshire

Summary: Article 14.NH: New Hampshire

MRWR-14NJ: New Jersey

Summary: MRWR-14NJ: New Jersey

New Mexico: Work Requirements in the Land of Provider Scarcity

Summary: New Mexico: Work Requirements in the Land of Provider Scarcity

Article 14.NV: Nevada

Summary: Article 14.NV: Nevada

Article 14.NY: New York

Summary: Article 14.NY: New York

Article 14.OH: Ohio

Summary: Article 14.OH: Ohio

MRWR-14OK: Oklahoma

Summary: MRWR-14OK: Oklahoma

Oregon: CCO Infrastructure Meets Federal Compliance

Summary: Oregon: CCO Infrastructure Meets Federal Compliance

Article 14.PA: Pennsylvania

Summary: Article 14.PA: Pennsylvania

Rhode Island: Small State, Outsized Implementation Challenges

Summary: Rhode Island: Small State, Outsized Implementation Challenges

Article 14.SC: South Carolina

Summary: Article 14.SC: South Carolina

MRWR-14SD: South Dakota

Summary: MRWR-14SD: South Dakota

Article 14.TN: Tennessee

State Profile
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