State lawmakers in Indiana have voted to impose work requirements as a condition of eligibility for able-bodied adults added to that state’s Medicaid program through Obamacare expansion.

Under the Indiana legislation, able-bodied individuals between the ages of 19 and 64, most of whom were added to the program through Medicaid expansion incentivized by the federal Affordable Care Act (better known as “Obamacare”), will be required to either work or volunteer for 20 hours each week, with exceptions for caregivers, disabled beneficiaries, and similar groups.

Medicaid is Indiana’s fastest-growing expense and is on pace to eventually outpace K–12 education spending—which comprised up to half the Indiana state budget until recently.

If the legislation becomes law, Indiana officials will have to obtain permission from the federal government before work requirements can be implemented.

Medicaid is also a growing budget problem in Oklahoma, with much of the financial stress associated with the program’s Obamacare expansion, which took effect in 2021.

In 2021, the year Medicaid expansion took effect in Oklahoma, the state Medicaid program spent $5.99 billion in total. By 2024, total spending had surged to $10.3 billion.

As of February, the expansion population comprised 22 percent of the total enrollment in Oklahoma’s Medicaid program and represented nearly 47 percent of adults in the program.

When Medicaid was expanded in Oklahoma in 2021, proponents said the state taxpayer cost would total only $164 million annually, with the remainder paid by the federal government.

However, the state cost has already surged well beyond that point and may be poised to explode in a dramatic fashion that forces major budget decisions across state government.

A 2024 report by the Legislative Office of Fiscal Accountability, a state fiscal watchdog, estimated that Medicaid expansion would cost nearly $2.5 billion in the 2025 state budget year, with $213 million coming from state government.

At the same time, federal officials are reportedly considering changing the federal-state matching formula for Medicaid-expansion enrollees to boost the state share. If that happens, the state cost of the program could surge by $550 million to $700 million annually, an amount equivalent to a major state shortfall.

Research has consistently shown that hospital finances in Oklahoma are no better today, and often worse, than prior to Medicaid expansion, and Oklahoma’s rankings on health outcomes remain largely the same.