Native Hawaiians Excluded from Medicaid Work-Requirement Exemption Granted to Other Indigenous Groups
Native Hawaiians will have to satisfy new Medicaid work requirements, unlike Native American and Alaska Native groups that receive exemptions, prompting worries about reduced health access.
Under the One Big Beautiful Bill Act, most adult Medicaid beneficiaries in 43 states and the District of Columbia must log at least 80 hours per month of employment, education, training or volunteer work beginning in January. Native American and Alaska Native tribes are exempt, but Native Hawaiians were not granted the same relief after the Centers for Medicare & Medicaid Services cited the group’s lack of federal tribal recognition.
Hawaii’s Medicaid director noted that roughly 15% of the state’s 390,000 Medicaid members are Native Hawaiian, a community already facing higher pregnancy risks, infant mortality and uninsured rates. Health providers on Kaua‘i and O‘ahu warn that the new rule could strip care from thousands of patients, especially given transportation costs between islands and low local wages. Attempts by state officials to secure an exemption through the Trump administration and Congress have failed, and no comment was received from the White House. Lawmakers and advocates view the exclusion as part of a broader pattern of policies that undermine Native Hawaiian Indigenous status.
Why it matters
The rule could cut health services for thousands of Native Hawaiians already facing severe disparities.
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