Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio will not initially accept self-attestation alone.
Work requirements for some Medicaid recipients are scheduled to begin nationwide in January, but six states are adopting stricter medical-verification rules than the federal government requires during the first year.
The new mandate applies to certain adults enrolled through Medicaid expansion. Affected recipients generally must work or volunteer for at least 80 hours per month or attend school at least half time. People considered medically frail may qualify for an exemption.
Federal rules allow recipients to initially attest that a medical condition prevents them from meeting the requirement. Arkansas, Idaho, Indiana, New Hampshire, North Carolina and Ohio will instead require documentation immediately.
Supporters say medical records or other evidence are necessary to deter fraud and preserve Medicaid for people who qualify. The Foundation for Government Accountability argues that accepting self-attestation alone weakens program integrity.
Patient advocates say some applicants cannot obtain medical documentation precisely because they lack insurance and cannot afford to see a doctor.
The Congressional Budget Office previously estimated that the broader Medicaid changes would reduce federal spending by $887 billion over a decade and leave 7.5 million fewer people insured.
