The Centers for Medicare & Medicaid Services (CMS) on March 5 announced its approval of Arkansas’ request to incorporate work requirements as a condition of Medicaid eligibility in its 1115 demonstration waiver, known as Arkansas Works.

The new requirements build on the state’s previously approved expansion waiver, which provided premium assistance for certain adult beneficiaries to purchase qualified health plan coverage through the individual insurance market.

Under the new provisions, Medicaid beneficiaries ages 19 to 49 beginning June 1 must work or participate in community engagement activities for 80 hours per month to maintain their eligibility. The work requirements will not apply to beneficiaries with severe mental conditions, pregnant women, primary caregivers, and those undergoing treatment for alcohol abuse or substance use disorders. Adults age 50 and older also are exempt, in alignment with requirements under the state Supplemental Nutrition Assistance Program.

CMS rejected a portion of Arkansas’ waiver request that would have limited eligibility for the expansion group to individuals at or below 100 percent of the poverty level.

Approval of work requirements in Medicaid marks a significant change in policy, as the only work-related waiver requirements approved by previous administrations were for referrals to job training and support programs. Arkansas is the third state to receive such approval from CMS this year, after Kentucky’s waiver was approved in January and Indiana’s waiver was approved in February.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.