Health · Healthcare & Policy · 1 hr ago
Native Americans Exempt From Medicaid Work Rules Face Risk of Losing Coverage
A federal law exempts Native Americans from Medicaid work requirements, but states still need to determine who qualifies for the exemption.
The Centers for Medicare & Medicaid Services issued guidance in June, but it did not set one standard way to verify tribal status.
States are developing different proof requirements, and some plan to let people identify their tribal status on Medicaid applications.
Tribal leaders say gaps in the process could cause eligible people to lose coverage, as happened during a 2023 review when an estimated 850,000 Native Americans lost Medicaid by May 2024, often over paperwork.
The exemption covers American Indians and Alaska Natives, but does not include some Indigenous people, including Native Hawaiians.
A CMS tribal advisory group has called for self-attestation and data-sharing with tribal health programs, while top Democrats are urging the administration to give states more time.
Tribal leaders expect further federal guidance, but say it may come too late to prevent states from setting their own processes.
Native Americans exempt from Medicaid work requirements could still lose coverage because states lack a standard process to identify who qualifies for the exemption.
Federal guidance issued by the Centers for Medicare & Medicaid Services left states to create their own eligibility checks.
KFF Health News found that 14 states plan to ask tribal citizens to prove their status in different ways.
Native leaders fear coverage losses could repeat problems from the 2023 Medicaid eligibility review.
A CMS tribal advisory group recommended allowing people to attest to their eligibility and requiring states to share eligibility data with tribal health programs.
- Who
- Native Americans enrolled in Medicaid, including members of federally recognized tribes, are affected.
- What
- They are exempt from Medicaid work requirements but could lose coverage if states cannot identify them correctly.
- When
- States were two months from the implementation deadline when the article was published on Nov. 13, 2026.
- Where
- The rules affect states across the United States; the article also describes the Eastern Band of Cherokee Indians in western North Carolina.
- Why
- Federal guidance did not set a standard way for states to verify Native American status, leaving states to develop their own processes.
This story does not have two clearly opposing sides.
States resumed checking Medicaid eligibility after a pause during the covid era.
An estimated 850,000 Native Americans had lost coverage, often for paperwork reasons.
CMS published guidance telling states to use existing data before potentially asking Native enrollees for additional records.
A CMS tribal advisory group recommended self-attestation as standard proof and called for states to share eligibility data with tribal health programs.
KFF Health News reported that states still lacked a standardized system for identifying Native Americans exempt from work requirements.
- Estimated coverage losses
- 850,000 Native Americans by May 2024
- States surveyed
- KFF Health News asked 14 states about their plans
- States allowing self-identification on applications
- Arizona, Colorado, Montana, Nevada, New Mexico and Washington
- Guidance published
- June 2026
- Eastern Band of Cherokee Indians
- Qualla Boundary, western North Carolina
3 sources
What people are saying
I’m nervous. I’m extremely nervous,
When you look at any state that’s rolled out Medicaid work requirements, the unintended consequences have been vast, and that’s what we don’t want to happen.
There’s 30-plus states who are independently repurposing their administrative processes for this, and they really all happen in a vacuum,
That’s why it’s really important for CMS to provide guidance.