Six Republican-led states will require documentation from Medicaid enrollees who claim to be too sick to work, instead of accepting their word as federal rules allow in 2027

Medicaid work requirements from Trump's 2025 tax law start in January. People who cannot meet them because of poor health can claim a medical-frailty exemption (a waiver for those too sick to work). In the first year, federal rules let states take people at their word on that claim. At least six Republican-led states will not. Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio will demand documentation instead. They are declining an option, not breaking the rule. The case for. Jonathan Ingram of the Foundation for Government Accountability, a conservative policy group: “Self-attestation is fraud-by-design.” The case against. KFF's Jennifer Tolbert says people too sick to work often can't afford the doctor visit that would prove it: “Medicaid is saying you need documentation from a provider.” Advocates warn this will block new applicants. What next. Democrats in 25 states are suing over the rules, and the requirements begin in January 2027.

What the paperwork rule adds before and after enrollment:

• Applicants must prove compliance for the month before they apply; Idaho and Indiana require three months.
• From Jan. 1, 2028, every state must verify exemptions with data or documents, so the six states are moving a year early.