What you need to know about welfare work requirements in Illinois

Congress just put work requirements in place for some receiving federal health care and food assistance benefits. What does that mean for the 1-in-4 Illinois residents currently on Medicaid?

Congress is attaching work requirements for more of the people receiving federal health care and food assistance benefits, which will impact 3.4 million Illinoisans on Medicaid and 1.9 million receiving Supplemental Nutrition Assistance Program benefits

Congress passed the changes July 4 as part of the One Big Beautiful Bill Act, recognition that the federal programs have created generations of dependency that were hard to escape and robbed people of dignity.

Medicaid enrollment has surged in Illinois since the state opted to expand the program under the Affordable Care Act in 2014. It extended Medicaid eligibility to anyone in households earning up to 138% of the federal poverty level regardless of disability or health status. This added 843,000 able-bodied Illinoisans to Medicaid, who can benefit from the new work requirements as a path out of poverty.

What are work requirements?

Work requirements link work and welfare, ensuring able-bodied recipients work or participate in the community to maintain their benefits. Beneficiaries must perform at least 80 hours per month of work, community service, job or vocational training or be enrolled at least half-time in school. Some individuals are exempt from the work requirement.

Individuals must verify completion of these activities by submitting documentation monthly to their home state. If they do not, they receive a warning from the state and 30 days to show compliance. If none is shown, the state will remove the individual from the Medicaid program.

Who do the new Medicaid work requirements target?

These requirements apply only to able-bodied individuals between ages 19 and 64 without dependents under age 14. People in the following groups are exempt from the requirement:

• Caretakers of disabled individuals.
• Pregnant women or those entitled to postpartum medical care.
• Current or former foster youth under age 26.
• Those with a physical, intellectual or developmental disability.
• People suffering from a serious or complex medical condition.
• Mental health program participants.
• Individuals already meeting another program’s work requirements.
• Native Americans and Alaska Natives.
• Incarcerated individuals or those released from incarceration within 90 days.
• People entitled to Medicare Part A or Part B

Exempt individuals must verify their status with the state to keep their benefits. Also, new non-exempt applicants must meet work requirements for three consecutive months before becoming eligible to enroll in Medicaid.

When do changes go into effect?

States must administer these new work requirements by Dec. 31, 2026, although they can obtain a special waiver allowing them to do so before that date. With valid justification, states may also apply for delayed implementation until the end of 2028 at the latest. The U.S. Department of Health and Human Services will issue guidance to the states by the end of 2025.

How many people currently meet the requirements?

An American Enterprise Institute report found only 44% of current non-exempt Medicaid recipients in the United States work enough to meet the 80-hour per month requirement. Assuming those numbers are similar in Illinois, around 370,000 beneficiaries will join the workforce.

Do states have flexibility in implementing work requirements?

While the law requires states to adopt these new work requirements, they have administrative latitude in designing systems to verify recipients’ activity documentation or exempt status. States may also opt to exempt the following groups:

• Recent residents of in-patient medical facilities.
• Residents of counties that have experienced emergencies, disasters or high unemployment.
• Patients who must spend time in another locality to receive necessary medical services.

How are SNAP’s work requirements changing?

The Supplemental Nutrition Assistance Program provides beneficiaries with food budget supplements and already requires non-exempt recipients between ages 18 and 54 to work or participate in the community at least 80 hours per month. Individuals are exempt if they care for an incapacitated person or child under age six, participate in a substance treatment program or are unable to work because of physical or mental limitations.

The new legislation expands the age range for these requirements to apply to non-exempt recipients between ages 18 and 64, and also includes individuals with dependents aged 14 and older.

Are work requirements popular?

Yes. A February 2025 survey showed 71% of Americans favor adding work requirements for working-age, able-bodied Medicaid recipients. In June a poll by The Economist/YouGov showed more people supported adding work requirements than were against, regardless of the respondent’s income level.

Why do some worry about work requirements’ impact?

Some are concerned administrative burdens will cause widespread unenrollment, even among those who satisfy the requirements. This occurred in previous programs enacted by Arkansas and Georgia. The Congressional Budget Office, the government’s nonpartisan legislative analyst, estimated 7.8 million people nationwide could lose coverage by 2034, including between 193,000 and 220,000 Illinoisans.

These estimates overlook two important matters. First, if Illinois applies lessons from previous programs’ administrative failures, these bleak projections will be avoided. Second, many of the people who are projected to no longer receive Medicaid coverage will instead have private health insurance through their employer.

Work requirements can help boost Illinois’ lagging labor force participation and employment rates, and facilitate growth in the state’s economy. But more importantly, they can help people earn their way out of generations of poverty and boost their self-worth.

If Illinois promotes transparency and minimizes red tape during implementation of the work requirements, it can empower its people and boost its economy.