# States Struggle to Implement New Medicaid Work Rules, Survey Finds  
**Published:** 2026-04-30T13:40:41.000Z  
**Source:** [Kentucky Lantern](https://kentuckylantern.com/2026/04/30/repub/many-states-unsure-how-to-implement-new-medicaid-work-requirements-kff-survey-finds/)  
**AI-generated:** yes (claude-haiku-4-5-20251001)  
**Canonical:** https://feeds.lexingtonky.news/article/states-struggle-to-implement-new-medicaid-work-rules-survey-finds

State officials say they need more information from the federal government before they can fully implement new Medicaid work requirements that will reshape eligibility for millions of Americans, according to a survey released Thursday by the Kaiser Family Foundation and Georgetown University.

[The survey of Medicaid program officials from 43 states](https://kentuckylantern.com/2026/04/30/repub/many-states-unsure-how-to-implement-new-medicaid-work-requirements-kff-survey-finds/) found significant confusion about how to apply [provisions in the One Big Beautiful Bill Act](https://www.congress.gov/bill/119th-congress/house-bill/1/text) that require Medicaid enrollees ages 19 to 65 to work, volunteer, attend school or participate in community service for at least 80 hours per month.

Officials requested clearer guidance on defining medical frailty and other key exemptions, determining what activities qualify as community service, verifying work compliance, and calculating part-time school attendance. The survey also revealed states need clarification on the caregiver exemption and how long verification of exemptions should remain valid.

[Kentucky was among states that had not finalized its implementation timeline](https://www.kff.org/medicaid/an-early-look-at-policy-decisions-as-states-get-ready-to-implement-work-requirements/) at the time the survey was conducted between January and March 2026. However, [the Kentucky General Assembly recently overrode the governor's veto to codify work requirements into state law](https://ballotpedia.org/Medicaid_work_requirements_during_the_Trump_administrations).

The vast majority of states said they would implement the new requirements on January 1, 2027, as mandated by federal law. However, Nebraska became the first state to begin enforcement on May 1, while Montana plans to start July 1. Iowa officials indicated implementation this year, though without a specific date. Arkansas announced a "soft launch" for July without removing anyone from Medicaid for noncompliance until next year.

Nearly all states plan to allow hardship exemptions for people in counties with high unemployment, those who recently experienced natural disasters, and those needing to travel for medical care. Indiana and Iowa are the only states that do not intend to allow any hardship exemptions, while Oklahoma, Missouri and New York opted out of specific exemptions.

States diverged on how far back to look when determining compliance. Thirty-six states will examine one month before application, while Indiana and Idaho will look back three months. Thirty-four states will review one month during renewal, with Indiana and New Hampshire checking quarterly.

[Federal guidance is not expected until June](https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/), leaving states little time before they must begin notifying affected beneficiaries in September 2026. The Congressional Budget Office estimates the work requirements will reduce Medicaid spending by $344 billion over 10 years and result in 4.8 million additional uninsured people.

## Sources

- [Kentucky Lantern](https://kentuckylantern.com/2026/04/30/repub/many-states-unsure-how-to-implement-new-medicaid-work-requirements-kff-survey-finds/)
- [KFF and Georgetown University survey of 43 states on Medicaid work requirements implementation](https://www.kff.org/medicaid/an-early-look-at-policy-decisions-as-states-get-ready-to-implement-work-requirements/)
- [One Big Beautiful Bill Act requiring 80 hours monthly work or community service for Medicaid enrollees](https://www.congress.gov/bill/119th-congress/house-bill/1/text)
- [Kentucky General Assembly overrode governor's veto on Medicaid work requirements](https://ballotpedia.org/Medicaid_work_requirements_during_the_Trump_administrations)
- [Federal guidance timeline and implementation tracker](https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/)

---

This article was generated by AI (claude-haiku-4-5-20251001) based on source material from Kentucky Lantern, enriched with 3 web searches. The original source is available at https://kentuckylantern.com/2026/04/30/repub/many-states-unsure-how-to-implement-new-medicaid-work-requirements-kff-survey-finds/.