On April 14, 2026, the Kentucky General Assembly voted along party lines to override line-item vetoes issued by Gov. Andy Beshear on House Bill 2, making changes to Medicaid rules law. Beshear had vetoed several sections, including a requirement that applicants show three months of compliance with new work requirements before becoming eligible for benefits. All 80 Republicans in the House and all 32 in the Senate voted to override the vetoes, while no Democrats supported the move.
Kentucky is one of four states with a veto-proof legislature and a governor from the opposing party, along with Kansas, North Carolina, and Vermont. In these states, one party holds enough seats in both chambers to override a governor’s veto without bipartisan support. Kentucky currently has a Democratic governor and a Republican-controlled legislature.
Background
The 2025 One Big Beautiful Bill Act requires states to implement community engagement requirements for able-bodied adults ages 19–64 without dependents in the ACA Medicaid expansion group by January 1, 2027. These requirements can be met by completing 80 hours per month of:
working,
community service,
participating in a work program, or
a combination of these activities.
Individuals may also qualify by enrolling at least part-time in an educational program or earning a monthly income equal to at least 80 times the federal hourly minimum wage. Failure to meet these requirements could result in denial of Medicaid coverage or removal from the program.
Before the law’s passage, there were no federal mandates requiring work participation for Medicaid. States could apply for Section 1115 waivers to implement such policies. During the first Trump administration, 13 states received approval for work requirements, though most were halted by legal challenges. The Biden administration later withdrew all 13 waivers. Georgia was the only state to successfully defend its waiver and began enforcing work requirements in 2023.
The federal law also expanded work requirements for the Supplemental Nutrition Assistance Program (SNAP).
Additional provisions and vetoed sections
Beshear vetoed 12 sections of HB 2, including provisions related to copays, benefit definitions, and the timeframe for demonstrating work requirement compliance.
One vetoed provision would have required Medicaid recipients to pay a $5 copay for services. In his veto message, Beshear argued the requirement could reduce federal funding and said the fixed amount was too restrictive. He did not veto a separate provision requiring a $1 copay for prescription drugs.
Another section stated that the state would not provide Medicaid benefits or spend funds on services not explicitly authorized by the General Assembly or required under federal law. Beshear said he rejected this measure to prevent the exclusion of services currently covered but not specifically listed in statutes.
Regarding the three-month compliance requirement, Beshear said it imposed stricter rules than necessary, adding administrative complexity and increasing the risk of eligible individuals losing coverage due to temporary gaps in employment, health, or caregiving responsibilities.
Under federal law, states must require at least one month—but no more than three months—of demonstrated compliance before granting benefits.
Actions in other states
Following the federal law’s passage, several states have begun implementing or formalizing Medicaid work requirements:
Nebraska plans to implement the requirements on May 1 using a state plan amendment.
Montana is set to begin enforcement in July.
Arkansas will roll out requirements on July 1 but will delay penalties for noncompliance until January 1, 2027.
Missouri’s HJR154 would add work requirements to the state constitution and require one month of compliance before applying.
Idaho’s HB 913, signed April 10, requires three consecutive months of compliance before enrollment.
Indiana’s SB0001, signed March 4, includes a similar three-month compliance requirement.
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