On May 7, New Hampshire became the fourth state approved to implement a work requirement for certain Medicaid beneficiaries. The AMA opposes work requirements as a condition of Medicaid eligibility. As of Jan. 1, 2019, New Hampshire will require adult, non-elderly, non-disabled Medicaid beneficiaries to participate in 100 hours per month of "community engagement activities" such as employment, education, job skills training or community service.

Certain individuals, such as those who are pregnant, medically frail, or caring for a young child, are exempt. The work requirement was a key condition for state legislators who reauthorized the state's Medicaid expansion program this year.

Kansas also requested federal approval to impose a work requirement on certain Medicaid beneficiaries and additionally proposed to limit lifetime coverage eligibility to 36 months even if those work requirements were met.

On May 7, CMS notified the state that it would deny the state's request to impose a 36 month lifetime limit on Medicaid benefits. CMS did not render a decision on work requirements without a lifetime limit. Kansas has not expanded Medicaid under the ACA, and, to date, CMS has only approved work requirements in Medicaid expansion states (Arkansas, Kentucky, Indiana and New Hampshire).