The Medicaid work requirement and what to do now

What the rule says

The Centers for Medicare and Medicaid Services, or CMS, is the federal agency that oversees Medicaid. On June 1, 2026, CMS published an interim final rule that explains how states must carry out the new law. An interim final rule is a rule that takes effect while the public is still allowed to send comments. CMS also uses another name for the requirement, which is community engagement.

Under the rule, an adult it covers must show 80 hours of qualifying activity in a month. This is needed to enroll or to keep coverage. A state checks this when you apply and when your coverage comes up for renewal, and it may also check more often if it chooses.

This page explains what CMS and state agencies have published. Rules can change and states are still making choices, so check your state's Medicaid website for its latest plan.

Who has to meet the rule

CMS says the rule covers non-pregnant adults between ages 19 and 64 who are not on Medicare. They must be eligible for, or enrolled in, the Medicaid adult group, which is the group states added when they expanded Medicaid. It also covers adults in certain special state programs that give similar coverage. CMS counts 43 states and Washington, DC, as places that cover these adults and must carry out the rule.

Our guide on who qualifies for Medicaid explains the adult group in more detail. Children and people over 64 are not in it, and people who qualify through a disability usually are not either.

Who is exempt

CMS lists several kinds of adults who do not have to meet the requirement. Each one is described in the list below.

• Pregnant adults are exempt, and so are adults who are eligible for postpartum coverage in their state.
• Parents, guardians and caretakers of a child who is 13 or younger, or of a person with a disability, do not have to meet the rule.
• Medically frail adults do not have to meet it, and CMS describes this as having special medical needs that greatly limit the ability to meet the rule.
• American Indians and Alaska Natives do not have to meet the requirement.
• Young adults who aged out of the child welfare system also have an exemption.
• Veterans with a total disability rating have an exemption as well.
• People who are in jail or prison are exempt, and people who were recently released are treated as meeting the rule.
• Adults who are in a drug or alcohol treatment program are exempt too.
• People who get SNAP food benefits and already have to follow SNAP's work rules are exempt. People who meet the work rules of TANF, a cash help program, are also exempt.

States may also offer short-term hardship exceptions if they choose to. CMS gives a few examples of these hardships. One is a stay in a hospital. Another is a trip outside your community for medical care you cannot get nearby. A third is living in a county with very high unemployment or a disaster declaration.

What counts toward 80 hours

CMS says you can meet the rule for a month in any of the ways below.

• You work for pay, do community service or take part in a work program for at least 80 hours.
• You are enrolled in school at least half time.
• You mix those activities to reach 80 hours in total.
• You earn at least the federal minimum wage times 80 hours, which CMS says is $580 a month in 2026.

Seasonal workers are counted with a different formula. CMS's list does not include looking for a job, so ask your state whether job searching counts where you live.

When the rule starts in your state

The deadline is January 1, 2027. CMS says a state can choose an earlier date.

Nebraska is one state that moved early, and its health department said the rule would take effect there on May 1, 2026. It covers adults ages 19 to 64 in Medicaid expansion, who must complete at least 80 hours a month.

Georgia runs a program called Pathways to Coverage. It asks adults with incomes at or below the poverty line to complete 80 hours a month of qualifying activities. KFF keeps a tracker that lists other states with early dates, and you should check your state's site before you rely on any date.

How you will prove it

MACPAC, a federal advisory group on Medicaid, reads the rule this way. States must first check the records they can reach, such as wage data, without asking you for anything extra. If those records are not enough, a state may ask for papers or accept a signed statement. Over time, the rule moves toward asking for documents first.

If the state cannot confirm that you meet the rule, CMS says it must send you a notice. You then have 30 calendar days to show that you meet the rule or that you are exempt. If you do not respond, your application might be denied or your coverage might end. CMS also says a person who loses coverage can reapply at any time.

New applicants may need to meet the rule for at least one month before the month they apply. Good records of your hours help, such as pay stubs, a school schedule or a letter from a place where you volunteer.

What you can do now

1. Find out if you are in the expansion group. Your Medicaid letter or online account should say which program you are in.
2. Read every notice from your state and keep your address and phone number up to date. A missed letter can start the 30-day clock without you knowing it.
3. Save proof of your work, school or volunteer hours each month.
4. If you may be exempt, tell the state and ask what proof it accepts. A caregiver, a person with a health condition or a person in treatment may qualify.

If you lose coverage, a community health center charges by income and sees everyone. You can also search for a cash-pay doctor or read about health insurance without a job. If you live in a state that did not expand Medicaid, the Medicaid coverage gap guide explains your situation. This page is general information and not medical advice. In an emergency, call 911 or go to the nearest emergency room.