Medicaid
Sep 2, 2026

Native Hawaiians must meet new work mandates for Medicaid

Federally recognized tribes given exemptions from new work rule


September 2, 2026

At the start of 2027, new work mandates attached to Medicaid will go into effect as a result of the One Big Beautiful Bill Act. Many Native Americans and Alaska Natives are exempt from the new requirements – but Native Hawaiians won’t enjoy those protections awarded to other Indigenous people in the U.S.

Ashley Mizuo for KFF Health News reports that Native Hawaiians will need to comply with the new stipulation that adults work, go to school or enter a training program for at least 80 hours a month in order to qualify for Medicaid. The Native Hawaiian population isn’t federally recognized as a tribal nation, hurting their ability to qualify for the exemptions. 

The U.S. Centers for Medicare and Medicaid Services said in a statement that the agency met with 16 health centers in Hawai’i about Medicaid changes. The state of Hawai’i requested an exemption for Native Hawaiians like the ones that apply to Medicaid enrollees from other tribes. Mizuo reports the agency did not respond to the state’s request for the exemption.

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