Medicaid Work Requirements Explained

Beginning on January 1, 2027, adults ages 19 to 64 who receive coverage through Medicaid expansion under the Affordable Care Act (ACA) and certain enrollees in Section 1115 Medicaid waiver programs must meet Medicaid work requirements, unless they qualify for an exemption.

If you aren’t exempt, you must show proof that you are working, participating in a job-training program, in school, or volunteering. Learn about these requirements and whether you qualify for an exemption to protect your coverage.

Requirements and documentation rules vary by state, so Medicaid enrollees should confirm with their state Medicaid office before making any coverage decisions.

Select your state below to learn more about its coverage requirements.

Note: The following states did not adopt Medicaid expansion, which means that Medicaid work requirements may not apply in these states:

• Alabama

• Florida

• Georgia*

• Kansas

• Mississippi

• South Carolina

• Tennessee*

• Texas

• Wisconsin*

• Wyoming

* While these states did not adopt Medicaid expansion, they may still impose work requirements through waivers or broad federal legislation.

Georgia launched Georgia Pathways to Coverage in July 2023. The limited Medicaid program requires some adults to complete at least 80 hours a month of work, school, job training, volunteering, or another approved activity to qualify. This is separate from the new nationwide Medicaid work requirement.

Medicaid work requirements (also called community engagement requirements) for Medicaid recipients who don’t qualify for an exemption begin nationwide on January 1, 2027. However, some states have started before the deadline:

• December 1, 2026: Iowa
• July 1, 2026: Arkansas, Montana
• May 1, 2026: Nebraska
• July 1, 2023: Georgia*

States can also request an extension of the Medicaid work requirements until December 31, 2028, if the state can demonstrate a good-faith effort to meet the requirements.

Over 65 million Americans rely on Medicaid.

In fact, 92% of Medicaid-covered adults are already working or aren’t working due to caregiving responsibilities, school attendance, or because they’re dealing with an illness or disability.

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’ll need to prove each month that you’re meeting these work or community engagement requirements to keep your Medicaid coverage.

Medicaid work requirements apply to:

• Some adults ages 19 to 64 who receive Medicaid through Medicaid expansion under the Affordable Care Act, which covers adults with incomes up to 138% of the federal poverty level.

• Certain adults ages 19 to 64 who are enrolled in certain Medicaid waiver programs, called Section 1115 waivers. The coverage must meet the federal definition of “minimum essential coverage.”

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.

You don’t have to meet Medicaid work requirements if you are:

• Under the age of 19 or above the age of 64.

• The parent, guardian, or caregiver of a child aged 13 or under.

• Caring for a person with a disability.

• Pregnant or gave birth within the last 12 months (depending on your state).

• Receiving Supplemental Security Income (SSI), entitled to or enrolled in benefits under Medicare Part A, or enrolled in benefits under Medicare Part B.

• Diagnosed with a physical, intellectual, or developmental disability, including disabling mental disorders.

• Medically frail, demonstrating an impaired capacity to meet work requirements. 

• A veteran with a total disability rating.

• A member of a federally recognized tribe or an individual who is eligible to receive Indian Health Service (IHS).

• Incarcerated or were recently incarcerated in the last three months.

• Participating in a qualifying substance use disorder (SUD) treatment program.

• Already meeting work requirements through programs including Temporary Assistance for Needy Families (TANF) or the Supplemental Nutrition Assistance Program (SNAP).

• Currently a foster youth or former foster youth under the age of 26.

• Facing a short-term hardship, such as:

  • Receiving care in a hospital, nursing facility, psychiatric facility, or other intensive care settings.

  • Part of a federally declared disaster area.

  • Living in a county with an unemployment rate higher than 8%.

  • Required (either you or your dependents) to travel outside of your home for medical care for an extended time.

Note: Your state Medicaid agency follows federal rules to determine if Medicaid work requirements apply to you. However, some exemptions can vary by state. Always check with your state Medicaid agency to confirm which exemptions apply to you or not.

If you do not qualify for an exemption under the work requirements for Medicaid, you must either:

• Show that your household income is at least $580 a month.

• Work at least 80 hours each month in one or more qualifying activities, such as paid work, half-time enrollment in a higher education program, or community service.

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.

To ensure you’re following the Medicaid work requirement, you can meet one (or a combination) of these options:

• Paid employment: Working at least 80 hours per month in any paid job.

• 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.

• Seasonal work: Having an average monthly income over the last six months of at least $580.

• Work program: Completing 80 hours per month in an approved work program or job training.

• Community service: Completing at least 80 hours per month of community service activities, such as volunteering.

• Education: Enrolling in an educational program at least half-time at an institution of higher education, a career or technical education program, a high school, or high school equivalency program.

Note:  If you fail to respond to your state Medicaid office that you qualify for an exemption from Medicaid work requirements within 30 days, you could lose your Medicaid coverage. This is also called disenrollment. 

Keep your Medicaid coverage updated by contacting your state Medicaid office.

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:

• More reporting and check-ins with your state Medicaid agency.

• Higher risk of disenrollment if forms are late or incomplete.

• 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 insurance, including any medications or supplies.

If you rely on these benefits, it’s important to stay up to date on policy changes and check your coverage.

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 said they 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. 

However, while Medicaid may be changing, there are a few things you can do to reduce the chance of losing your coverage. Here’s how:

1. 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.

2. 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.

3. Contact your state Medicaid agency to check on your enrollment status and requirements. You can also check your physical mail and email (including your spam folder) for any communication from your Medicaid provider. Also, stay in contact with your insurance, and report any change, such as your household income, between now and January 1, 2027.