Key Takeaways:
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Starting January 1, 2027, some adults who receive Medicaid under the Affordable Care Act’s expansion must work 80 hours a month to keep their Medicaid coverage unless they’re exempt. However, some states, like Nebraska, are starting early in 2026.
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More than 72 million Americans rely on Medicaid, and one in four Medicaid recipients is covered through the ACA expansion.
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Check your Medicaid status, watch for state policy changes, and keep your work status and contact information up to date. This can help you keep your Medicaid benefits, including access to free incontinence supplies like diapers for eligible kids and adults with a medical need.
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Medicaid work requirements begin January 1, 2027 for some adults ages 19-64 enrolled in the ACA Medicaid expansion group, but some states have started earlier. For many, these requirements could mean filling out extra paperwork, such as showing proof that you’re working, in school, volunteering, or that you qualify for an exemption.
However, even if you qualify for an exemption, missing a form or deadline could still put your coverage at risk. It’s also important to stay updated on your Medicaid benefits, especially if you rely on your coverage for free incontinence supplies. Knowing what’s changing with Medicaid and whether your state is starting Medicaid work requirements sooner can help you protect your coverage.
When Do Medicaid Work Requirements Start?
Medicaid work requirements for Medicaid recipients who don’t qualify for an exemption will begin nationwide on January 1, 2027, but some states have started sooner:
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May 1, 2026: Nebraska
States can also request a temporary delay from the federal government, but any delay must end by December 31, 2028.
Medicaid Work Requirements Explained
When H.R. 1, also called the “Big Beautiful Bill,” became law on July 4, 2025, it set new work requirements for some adults on Medicaid.
If these rules apply to you or your loved one, you may need to prove each month that you’re meeting these work or community engagement requirements to keep your Medicaid coverage.
Who Do the Medicaid Work Requirements Apply To?
These requirements apply to some adults ages 19-64 who receive Medicaid through the Affordable Care Act’s Medicaid expansion, which covers adults with incomes up to 138% of the federal poverty level.
Medicaid work requirements will not apply to you if you qualify for an exemption.
However, even if you qualify for an exemption, if you don’t report it on time, the state can deny or end your coverage, meaning you may become uninsured.
Do You Qualify for an Exemption?
You don’t have to meet Medicaid work requirements if you are:
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The parent, guardian, or caregiver of a child aged 13 or under.
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Caring for a person with a disability.
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Pregnant or gave birth within the last 12 months (depending on your state).
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Receiving Supplemental Security Income (SSI), are considered disabled, or have a complex medical condition.
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A veteran with a total disability rating.
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A member of a federally recognized tribe.
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Incarcerated or were recently incarcerated in the last three months.
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Participating in a qualifying substance use disorder (SUD) treatment program.
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Already meeting work requirements through programs including Temporary Assistance for Needy Families (TANF) or the Supplemental Nutrition Assistance Program (SNAP).
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Currently a foster youth or former foster youth under the age of 26.
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Facing a short-term hardship.
How Many Hours Do You Have to Work?
If you do not qualify for an exemption under the new work requirements for Medicaid, you must work at least 80 hours each month.
Note: Depending on your state, you may need to prove you met the 80-hour requirement for one to three months in a row before you apply for Medicaid.
If you already have Medicaid, you’ll have to show you met the requirement at least once at renewal. Renewals for adults under Medicaid expansion happen every 6 months starting in January 2027, and some states may check more often.
What Counts Toward the Medicaid Work Requirement?
To ensure you’re following the Medicaid work requirement, you can meet one (or a combination) of these options:
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Paid employment: Working at least 80 hours per month in any paid job.
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Minimum wage equivalent: Earning at least $580 per month (the equivalent of 80 hours at the federal minimum wage of $7.25), including through self-employment or business income.
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Seasonal work: Having an average monthly income over the last six months of at least $580.
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Unpaid work program: Completing 80 hours per month in an approved work program or job training.
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Community service: Completing at least 80 hours per month of community service activities, such as volunteering.
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Education: Enrolling in an educational program at least half-time / part-time (40 hours per month).
What Do These Changes Mean for Medicaid Beneficiaries?
For many people, the biggest change is more paperwork, as you may have to prove and report your work or approved activities on time to keep coverage. Even if you’re exempt, missing a form or deadline could still put your Medicaid at risk.
This could mean:
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More reporting and check-ins with your state Medicaid agency.
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Higher risk of disenrollment if forms are late or incomplete.
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Coverage gaps that could leave you uninsured.
You should be aware that if you or your loved one receives Medicaid and fails to fill out the correct forms or doesn’t report a change, you may lose access to essential incontinence supplies, such as diapers or briefs.
If you rely on these benefits, it’s worth staying up to date on policy changes and checking your coverage.
Check your coverage for 100% free incontinence products now!
Check your coverage for 100% free incontinence products now!
Have Medicaid Work Requirements Existed Before?
Yes, some states have previously implemented Medicaid work requirements.
In June 2018, Arkansas became the first state to require adults receiving Medicaid to meet work requirements.
When the policy was halted in 2019, 18,000 adults lost coverage. A study also found that 70% of recipients felt confused about reporting requirements.
The Congressional Budget Office (CBO) estimates that 4.8 million people will lose coverage nationwide by 2034 due to Medicaid work requirements.
What to Do if You’re on Medicaid
While Medicaid may be changing, there are a few things you or your loved one can do to reduce the chance of disenrollment, or losing your coverage:
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Keep your personal contact information and work status up to date with your local Medicaid office. If work requirements apply to you, begin planning now.
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Stay informed about policy changes to your state’s Medicaid program, especially if you rely on regular deliveries of supplies, like free diapers through Medicaid.
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Contact your state Medicaid agency to check on your enrollment status and requirements.
Frequently Asked Questions
Do you have to work to get Medicaid?
If you don’t qualify for an exemption, yes. Exemptions include having a disability or being the caregiver of a person with a disability. Medicaid work requirements are set to begin nationwide in January 2027, however, some states have started earlier.
Is there a work requirement for Medicaid?
Yes, each state must comply with Medicaid work requirements by January 1, 2027, unless the state files for an extension through December 31, 2028. However, some states have started to implement work requirements earlier. Visit your state’s Medicaid website to stay updated on the latest news around Medicaid work requirements.
How much can you make and still keep Medicaid?
Your income and Medicaid eligibility depend on the state you live in and your specific situation. Visit the official Medicaid website to find your state’s income limits.
I am already meeting work requirements because I have SNAP. What about Medicaid?
SNAP rules don’t automatically carry over to Medicaid. Once your state begins implementing work requirements, you may have to report your work hours separately to keep your Medicaid coverage, even if you already report them for SNAP.
Will Medicaid work requirements impact access to bladder control products?
You can lose access to bladder control products if you don’t meet certain Medicaid requirements. However, requirements vary by state. You can stay up to date on Medicaid work requirements by visiting your state’s Medicaid website. If you qualify for Medicaid, you can get free incontinence supplies through your insurance.
Mica Phillips
Mica has been at Aeroflow for over ten years. He brings creativity to a sometimes stagnant and complacent industry and tries his best to uncomplicate the complex world of Insurance. He is a graduate of the University of North Carolina and holds a Bachelor’s degree in English. In addition to his daily responsibilities as Executive Vice President of Aeroflow Urology, he’s contributed to numerous articles for online journals regarding senior care, incontinence, and navigating insurance benefits. In his spare time, he enjoys listening to live music, visiting breweries, and traveling the world with his wife and daughter.
References:
Brownstein, M. (2025, July 29). How Medicaid cuts could lead to loss of coverage for millions. Harvard T.H. Chan School of Public Health.
Center for Health Care Strategies. (2025, December). A Summary of Federal Medicaid Work Requirements.
Centers for Medicare & Medicaid Services. (2024, June). Medicaid expansion adult enrollment [Data set]. Medicaid.gov MAC Scorecard.
HealthCare.gov. (n.d.). Affordable Care Act (ACA).
Sommers, B. D., Chen, L., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2020). Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care. Health Affairs, 39(9), 1522–1530.
USAGov. (n.d.). Federally recognized Indian tribes and resources for Native Americans.
Vollers, A. C. (2025, April 13). 1 in 5 Americans are on Medicaid. Some enrollees have no idea. PBS NewsHour.
Disclaimer
Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.
