Louisiana takes a step toward adopting Medicaid work requirements

Louisiana’s proposed work requirements for Medicaid enrollment largely adhere to the new guidelines Congress and President Donald Trump laid out last year. The new state regulations are expected to go into effect for Medicaid recipients in January.

The proposed rules would necessitate many Medicaid enrollees between 19 and 65 years old to earn at least $580 per month or complete at least 80 hours per month at a job or volunteer opportunity in order to qualify for benefits. They may also enroll in school or job training part-time to meet the requirement.

The state health department first published the proposed work requirements in July and gathered public comments about the plan during August. They must clear a few more legal steps before being permanently adopted into law. 

Medicaid provides health insurance coverage for lower-income, pregnant and disabled people. Critics of the incoming work requirements said the restrictions will end up pulling benefits from many who should qualify for the assistance.

“Most people who lose coverage [due to work requirements] end up losing it for paperwork reasons … not because they aren’t working or refuse to work,” said Jan Moller, executive director of Invest in Louisiana, a public policy group that advocates for low-income families. 

Louisiana anticipates at least some people will be cut from the Medicaid program as a result of the work requirements. A state financial analysis published alongside the proposed rules in July estimates healthcare providers in the state will lose out on $14 million in the current fiscal year and $88 million in the fiscal year that starts July 1, 2027, from work requirements taking effect. 

State analyses accompanying the publication of the proposed work requirements also concluded they would have a “negative impact” on “family functioning, stability and autonomy,” as well as the state poverty rate.

The proposed rules provide for several exceptions to the work obligations for Medicaid recipients, however. 

Adults who aged out of the foster care system will continue to get their health coverage through Medicaid until they are age 26, regardless of whether they meet the work requirements. Likewise, people who receive Medicaid coverage because they are pregnant or postpartum won’t need to meet work obligations.

People in treatment programs for substance abuse will also be exempt. Those who have been incarcerated will also qualify for Medicaid without fullfilling the work requirements for the first 90 days after their release.

Critics worry at least one of these exemptions is likely to be confusing for Medicaid participants.

Following federal guidance, Louisiana’s proposed state rules would allow people to avoid the work requirements if they are deemed “medically frail.” 

Until a few months ago, many health care experts assumed “medically frail” would correlate to certain serious medical diagnoses outlined in a law Congress passed in 2025. But the latest set of federal rules indicates recipients will have to take extra steps starting in 2028 to prove their condition qualifies as one that makes it too difficult for them to work, volunteer or attend school. 

It’s not clear what documentation the “medically frail” enrollees will have to provide to keep their coverage. Democrat-led states are suing to stop this particular restriction from taking effect.