Some conservative states aren’t using Medicaid hardship exemption
States like Missouri and Iowa are choosing to not take up exemption designed to help low-income people keep coverage during hardship

TL;DR
- New federal work requirements for Medicaid are set to begin January 1st.
- Adults on ACA Medicaid expansion must work, attend school, or volunteer at least 80 hours a month to keep coverage.
- Federal exemptions exist for hardships like hospitalization or high unemployment.
- States like Missouri and Iowa are not adopting these hardship exemptions, despite qualifying areas.
- Experts suggest political and ideological reasons, as well as administrative burdens, for states not using exemptions.
- This leads to a 'patchwork of implementation' where some states minimize coverage losses, while others do not.
- Previous Medicaid work requirements in Arkansas led to significant coverage loss without increased employment.
- Experts express concern about widespread coverage loss due to these requirements and the complexity of exemption processes.