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Medicaid work requirements during the Biden administration
This page features information on Medicaid work requirements during the Biden administration.
Background of Medicaid work requirements
Medicaid, established by the Social Security Act of 1965, is a nationwide program that provides health coverage for qualifying individuals. The program is jointly funded by the federal government and the states. The states manage Medicaid eligibility, benefits, and administration within federal guidelines.
Medicaid work requirements are mandated work-related activities that Medicaid recipients must complete to qualify for benefits, such as working, pursuing education, participating in a work program, or volunteer activities. As of July 2025, Georgia was the only state with active Medicaid work requirements. The One Big Beautiful Bill Act, which was signed into law on July 4, 2025, requires states to implement a work requirement of at least 80 hours per month by January 1, 2027.[2]
Section 1115 waivers
Section 1115 of the Social Security Act gives the secretary of Health and Human Services (HHS) authority to approve any "experimental, pilot, or demonstration project which, in the judgment of the Secretary, is likely to assist in promoting the objectives of public assistance programs in a State or States." The Centers for Medicare and Medicaid Services (CMS) performs a case-by-case review of Section 1115 applications to determine whether the stated goals are aligned with Medicaid objectives. State applications for Section 1115 waivers must be budget neutral to the federal government, meaning that a state’s experimental project cannot increase federal Medicaid expenditures.[3]
Section 1115 waivers give states flexibility to design and improve programs by implementing state-specific policies to serve Medicaid recipients at the state level. Before the One Big Beautiful Bill Act (OBBB Act) mandated Medicaid work requirements for all states, Section 1115 waivers were the only way states could implement these requirements. The OBBB Act allows states to apply for Section 1115 waivers to implement work requirements for Medicaid ahead of the January 2027 deadline, but does not allow states to use these waivers to waive the work requirements.[3][2]
CMS approved Medicaid work requirement waivers in 13 of the 22 states that applied during the first Trump administration. Of these waivers, only Arkansas fully implemented its program before the Biden administration directed the agency to withdraw all approved waivers.[4] Georgia implemented Medicaid work requirements on July 1, 2023, through the Georgia Pathways program. Click here to learn more.
Medicaid work requirements during the Biden administration
This section provides information on activities affecting Medicaid work requirements during the Biden administration.
CMS withdrawal of Medicaid work requirements during the Biden administration
CMS withdrew 13 approved waivers for Medicaid work requirements during the Biden administration.
President Joe Biden (D) on January 28, 2021, issued Executive Order 14009 and directed HHS to review waivers that risk significant coverage losses.[5]
CMS in February 2021, began issuing final withdrawals for all states that had work requirement approvals under Section 1115 waivers. Though Arkansas filed suit arguing that its work requirements were lawful, the U.S. Supreme Court on March 11, 2023, removed the case from its docket and did not provide reasoning with its cancellation notification.[5][6]
Georgia Medicaid expansion and work requirements
Georgia lawmakers in 2019 passed Senate Bill 106, which created a state-developed protocol—known as Georgia Pathways—to return to historical Medicaid eligibility standards and implement a partial Medicaid expansion to cover adults with households below the poverty level who work at least 80 hours per month.[7]
Georgia submitted its Georgia Pathways plan to CMS in December 2019 and was approved for a Section 1115 waiver in October 2020, effective July 1, 2021. CMS notified Georgia that the work requirement for Medicaid eligibility was being reconsidered in February 2021. Georgia officials replied in March 2021, arguing that work requirements were part of their plan to expand Medicaid coverage, and suspended Medicaid expansion until work requirements were approved.[7]
Georgia filed a lawsuit against CMS and HHS in January 2022 and asked the United States District Court for the Southern District of Georgia to allow the state to proceed with Georgia Pathways as it was initially approved. The U.S. District Court for the Southern District of Georgia ruled in favor of the state on August 19, 2022, and allowed the state to move forward with Georgia Pathways.[7][8]
Georgia became the only state to have a Medicaid work requirement in place when Georgia Pathways took effect on July 1, 2023. The Georgia Department of Community Health (DCH) announced the launch of the Georgia Pathways to Coverage program on July 5, 2023. The program defines employment and training as qualifying work activities.[9][10]
See also
- Arguments about work requirements for public assistance programs
- Court cases related to work requirements for public assistance programs
- Scholarly work related to work requirements for public assistance programs
External links
Footnotes
- ↑ Kaiser Family Foundation, An Overview of Medicaid Work Requirements, accessed May 8, 2023
- ↑ 2.0 2.1 Congress.gov, "H.R.1 - 119th Congress (2025 - 2026)," July 4, 2025
- ↑ 3.0 3.1 Medicaid, Section 1115 Demonstrations, May 5, 2023
- ↑ Kaiser Family Foundation, An Overview of Medicaid Work Requirements, accessed May 8, 2023
- ↑ 5.0 5.1 Kaiser Family Foundation, Overview of Medicaid Work Requirements, accessed May 5, 2023
- ↑ JD Supra, Supreme Court Cancels Arguments on Medicaid Work Requirements, accessed May 25, 2023
- ↑ 7.0 7.1 7.2 Health Insurance, Georgia Medicaid, accessed May 26, 2023
- ↑ Court Listener, Georgia v. Lasure, accessed May 26, 2023
- ↑ The Hill, Georgia Medicaid Work Requirements, accessed July 13, 2023
- ↑ Georgia DCH, Georgia Pathways Resources, accessed July 13, 2023
