Medicaid āŗ Work requirements
Do Medicaid’s new work rules apply to me?
For adults under 65 on Medicaid, and families helping them. Who the rule covers, what counts, who is exempt, and how to stay covered.
The rule applies to adults 19 to 64 who get Medicaid through their state’s expansion group or a similar program. Anyone with Medicare Part A or Part B is exempt, so if you’re 65 and on Medicare, it does not apply to you. Most states must start by January 1, 2027. If it applies, you’ll need 80 hours a month of work, volunteering, school or job training, or at least $580 a month in income, unless you’re exempt.
Who has to meet the work rule?
The rule covers two groups of adults ages 19 to 64:
- The expansion group: the Medicaid group for adults under 65 with low incomes who are not on Medicare. Not every state covers it. See who qualifies.
- Similar state programs: coverage some states give these adults through a special federal agreement called a section 1115 waiver.
It applies in the 50 states and Washington, D.C. At 65, you leave the expansion group and the rule.
When does it start?
- Most states must start by January 1, 2027. If you’re already enrolled, it’s checked at your first renewal after your state starts.
- Nebraska started May 1, 2026 (Nebraska DHHS).
- Montana started July 1, 2026. Denials began in October 2026 (Montana DPHHS).
- Iowa starts December 1, 2026, for new applicants. Current members are checked at renewals from February 2027 (Iowa HHS).
- Arkansas began checks July 1, 2026, with no penalties in 2026. Full rules start January 1, 2027 (Arkansas DHS).
- Georgia did not adopt the full expansion. Its own Pathways program has required 80 hours a month since July 1, 2023.
- See your state’s date on our state-by-state page.
- Some states may start later. A state showing a good-faith effort can get a delay that ends by December 31, 2028. We found no public list of states that got one. Ask your state’s Medicaid agency.
What counts toward the 80 hours?
You meet the rule for a month if you:
- Work at least 80 hours.
- Do 80 hours of community service with a public agency or nonprofit that tracks hours.
- Spend 80 hours in an approved work or job-training program.
- Go to school at least half-time.
- Reach 80 hours with any mix of the four above.
- Have monthly income of at least $580. That is the federal minimum wage, $7.25, times 80 hours.
Seasonal workers can use their average monthly income over the past 6 months.
When will I have to prove it?
When you apply: for 1 to 3 months in a row just before the month you apply. Your state picks the number.
When you renew: for at least 1 month since your last check. Your state may check more often. It must first use records it already has, such as payroll data, before asking you for papers.
Renewals every 6 months. Starting with renewals scheduled on or after January 1, 2027, states must recheck the expansion group every 6 months, even people exempt from the work rule. If you’re already enrolled, your first 6-month cycle may start later in 2027.
Who is exempt?
If any of these fits you for a month, the rule doesn’t apply that month.
| Exemption | Who it covers |
|---|---|
| Medicare | You have Medicare Part A or Part B, for any reason, including disability |
| Age | You are under 19, or 65 or older |
| Caregivers | Parent, guardian, caretaker relative or family caregiver of a child 13 or younger, or of a person with a disability (who need not be on any benefit program) |
| Medically frail | You are blind or disabled under SSI’s definition, or have a substance use disorder, a disabling mental disorder, a disability that significantly limits everyday self-care (called activities of daily living), or a serious or complex medical condition |
| Veterans | A disability rated as total (100 percent), temporary or permanent |
| Other programs’ work rules | You meet TANF (cash assistance) work rules, or your household gets SNAP (food stamps) and you are subject to SNAP’s work rules |
| Treatment | You are in a drug or alcohol treatment and rehabilitation program |
| Jail or prison | You are held now, or were at any point in the past 3 months |
| Pregnancy | You are pregnant or getting postpartum coverage |
| American Indians | You are an American Indian, Urban Indian or California Indian, or eligible for the Indian Health Service |
| Former foster youth | You are in Medicaid’s group for former foster care youth |
| Other Medicaid groups | You qualify in certain other required Medicaid groups |
“Medically frail” differs by state. Each state writes its own list of conditions, and must let you ask to be considered if yours isn’t listed. CMS’s rule doesn’t count someone in recovery from substance use for 5 years or more.
The October 2026 court ruling. On October 29, 2026, a federal court in Massachusetts struck one part of CMS’s medically frail definition, the requirement that a condition “significantly impairs” a person’s ability to meet the work rule, and did not change the rule itself or its January 1, 2027 start date.
Short-term hardship (state option). Your state may also excuse a month spent in a hospital or nursing facility, a month when your county has a federal disaster declaration or high unemployment, or a long trip away for serious medical care. Ask whether your state offers these.
The law doesn’t say an SSDI award alone exempts you. Report it to your state Medicaid office and ask. Once Medicare starts, you are exempt.
What if my state can’t confirm I meet the rule?
Your state must send a notice. You have 30 days from receiving it to show you meet the rule or are exempt. Coverage continues during those 30 days.
Before ending coverage, the state must check whether you qualify another way. It must send a written notice that explains how to reapply and gives you the right to a fair hearing, your chance to appeal.
If you lose Medicaid for not meeting this rule, you also can’t get a premium tax credit (help paying the monthly premium) for a Marketplace plan on healthcare.gov.
How do I keep my coverage?
About half of the people expected to lose Medicaid under the rule would lose it to paperwork, not to failing the rule. CBO estimates the work rule will leave 5.3 million more people uninsured in 2034. CBO expects about 2.9 million people to lose Medicaid because they don’t meet the rule, and about 2.8 million more because the rule adds steps to the application process.
- Open every letter from your state Medicaid agency and answer by its deadline. Your state must tell you about the rule by mail and at least one other way, such as a text.
- Know your renewal month, and mark it on your calendar.
- Keep proof every month: pay stubs, a log of volunteer or program hours, or school records.
- Report an exemption as soon as it applies, such as a new diagnosis, caregiving, or Medicare starting.
- Update your address and phone whenever they change.
- Ask for help before a deadline. Call your state Medicaid agency.
Free tool: See if the rule is likely to apply to you, and what to keep on file.
Start āRelated
Sources. Public Law 119-21 (July 4, 2025), Ā§71119 (Social Security Act Ā§1902(xx)) and Ā§71107 (6-month renewals) Ā· CMS, “Medicaid Program; Community Engagement Requirement for Certain Individuals,” interim final rule CMS-2454-IFC, 91 FR 33348 (June 3, 2026; effective July 31, 2026), 42 CFR 435.550–435.563 Ā· CMS, State Medicaid Director Letter SMD 26-001, “Implementation of Eligibility Redeterminations” (Mar 6, 2026) Ā· U.S. District Court for the District of Massachusetts, No. 1:26-cv-12962, memorandum and order (Oct 29, 2026) Ā· Congressional Budget Office, supplemental cost estimate for Public Law 119-21, Title VII, Subtitle B, Chapter 1 (Oct 28, 2025) Ā· U.S. Department of Labor, federal minimum wage Ā· Nebraska DHHS, “New Medicaid Work Requirements Take Effect for Expansion Members” (Apr 30, 2026) Ā· Montana DPHHS, Medicaid changes FAQ (read Nov 12, 2026).
Last verified: November 12, 2026. This rule is changing quickly. We re-check it monthly, and whenever CMS or the courts act.
Benefits Insider is an independent publisher, not a government agency. This page is general information, not legal or financial advice for your situation. Work rules and exemption lists vary by state. For a decision on your case, contact your state Medicaid office.