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By Alice Miranda Ollstein and Robert King

08/09/2026 10:00 AM EDT

Democrats say the Trump administration’s new Medicaid work requirements — especially the narrow definition of who can get an exemption for medical reasons — are way too harsh.

Conservatives contend they’re not tough enough, and have convinced some Republican-led states to be even stricter.

The federal government gave states the option of allowing people to stay on Medicaid through 2027 if they declare themselves too sick to work, with verification starting in 2028. But at least eight states are rejecting that grace period and demanding proof earlier. Starting in January, Arkansas, Idaho, Indiana, Iowa, North Carolina, North Dakota, Ohio, and Utah will impose work rules stricter than those the administration is requiring.

Their decision underscores many conservatives’ belief that the expansion of Medicaid under Obamacare covered too many people that they consider unworthy of support, such as non-disabled, working-age adults without children. Democrats and advocates for low-income people say the harsher enforcement will cause many more sick people to join the ranks of the uninsured faster, putting the burden of caring for them on already-strained emergency rooms and public health clinics.