Nebraska began enforcing the new federal Medicaid work requirement on May 1. Montana and Arkansas followed on July 1. Every remaining expansion state has until January 1, 2027, roughly five months, to do the same thing.
What "the same thing" involves is not a policy tweak. States must rewrite eligibility rules, connect verification systems to payroll and wage databases, build a process for identifying who is exempt, design and mail compliant notices, train eligibility workers, and in some cases pass authorizing legislation. CMS estimates the average cost at roughly $15 million per state, about $660 million nationally.
