• Kentucky plans to implement new Medicaid work requirements for certain “able-bodied” adults.
• The program aims to connect recipients with job placement assistance, education, and training.
• Approximately 75,000 Medicaid expansion recipients are estimated to be affected.
• The state anticipates $184 million in Medicaid savings over five years.

Kentucky officials laid out how they plan to enact new Medicaid requirements in a public notice published May 13.

According to the notice, the state’s Department for Medicaid Services is seeking federal approval to implement a community engagement waiver program, with the goal of supporting “individuals in gaining economic stability” by connecting them to educational and job assistance programs.

The request comes after the Kentucky General Assembly passed a bill during the 2025 legislative session that requires some “able-bodied adults” to participate in such a program, after being approved and established by the Cabinet for Health and Family Services.

It also comes amid discussion of work requirements for Medicaid recipients nationally, with House Republicans proposing changes to the program as they attempt to reduce billions in spending.

Here’s what to know about the state’s proposal.

Who would be required to participate in Kentucky’s community engagement waiver program?

According to the public notice, the program would apply to adults in the state’s Medicaid expansion, who have been enrolled for more than 12 months and:

• Are between 19 and 60 years old;
• Are physically and mentally able to work, as defined by the Cabinet for Health and Family Services;
• Are not primarily responsible for the care of a dependent child or disabled adult relative.

Who could be exempt from Kentucky’s program?

The notice states the Department for Medicaid Services will review members for possible exemptions and will not require participation for those who meet one or more criteria, including:

• People with diagnosed substance use disorder or serious mental illness;
• People with a chronic disease or acute medical condition that prevents them from complying with requirements;
• People who have been deemed disabled;
• People with verified earned income or who receive unemployment insurance;
• Pregnant women;
• People who are victims of domestic violence;
• People who are homeless or were recently homeless;
• People who have recently been impacted by a catastrophic event, such as a natural disaster or death of a family member in their household;
• Former foster youth up to age 26.

How will Kentucky’s community engagement waiver program work?

Under the proposal, the Department for Medicaid Services will refer eligible adults to the Kentucky Education and Labor Cabinet’s Department of Workforce Development.

That department will then reach out to members with available job placement assistance programs.

“For individuals who agree to receive support, DWD will connect them with supports such as apprenticeships, career development, education, employment and training, and will provide support in preparing them to enter the workforce, advance their careers, improve job performance, and fill skills gaps,” the notice states.

How many people are expected to be eligible for the program?

The public notice estimates around 75,000 people will be “subject to the requirements of this waiver.”

About 488,000 people were covered by Kentucky’s Medicaid expansion as of 2024, according to federal data.

Officials expect “a minimal impact to enrollment” as recipients “are able to identify gainful employment through the community engagement process and therefore are no longer eligible for Medicaid,” the notice states.

How could the program effect spending on Medicaid?

Kentucky officials expect to spend less on Medicaid as expansion recipients gain employment through the community engagement waiver program.

According to the notice, the state expects to spend $184 million less over five years than it would without the program.

Why is Kentucky seeking a community engagement waiver program?

Earlier this year, lawmakers passed House Bill 695, which made sweeping changes to the state’s Medicaid program.

That included the controversial requirement for able-bodied adults to participate in a community engagement waiver program, including potentially requiring recipients to work 20 hours per week.

The bill drew widespread support from Republicans and criticism from Democrats. Critics of work requirements say they’re “another way to cut coverage,” while supporters say it “demands that those who can put forth the effort do.”

A similar measure was previously introduced by former Gov. Matt Bevin in 2018, which would have required able-bodied adults to work or volunteer at least 20 hours a week or facing losing health coverage. That decision drew a lawsuit from health law advocates, and Bevin’s proposal was eventually blocked by a federal judge.

How can Kentuckians have input in the program?

The Department for Medicaid Services will hold two public forums on the program, one virtually and another in person.

The virtual forum will take place at 10 a.m. May 22. Find information for the call in the public notice at chfs.ky.gov/agencies/dms/Pages/Medicaid-SUD-1115-Waiver.aspx.

An in-person forum will take place at 10 a.m. May 23 at the Kentucky Transportation Cabinet auditorium at 200 Mero St. in Frankfort.

Public comments can also be submitted by June 12 by email to KY1115CommEngagement@mslc.com or by mail to Kentucky Medicaid Section 1115 Comment, c/o DMS Commissioner’s Office, 275 E. Main St. 6W-A, Frankfort, KY 40621.

Reach reporter Hannah Pinski at hpinski@courier-journal.com or follow her on X, formerly known as Twitter, at @hannahpinski.