Medicaid Work Requirements: Who Must Comply, Who Is Exempt

Here's the short answer. Under a federal rule issued June 1, 2026, some adults on Medicaid must show 80 hours a month of work or other qualifying activities to get or keep coverage. It applies to adults ages 19–64 in the Medicaid expansion "adult group" who aren't on Medicare. Many people are exempt. That includes parents of young children, people who are medically frail, and pregnant women. States must apply the rule no later than January 1, 2027. Some may start earlier. The official name is the "community engagement" requirement.

Who Has to Meet the Requirement

The rule applies to adults who are all of these things at once:

• Between ages 19 and 64.
• Not pregnant.
• Not entitled to or enrolled in Medicare.
• Eligible for or enrolled in the Medicaid expansion adult group. Certain similar state programs under "section 1115" waivers count too.

Today, 43 states and the District of Columbia cover these groups and will have to apply the rule. U.S. territories are not covered by this law. Do you get Medicaid another way — say, because of a disability? Then this rule may not apply to you. Your state will tell you if it does.

Who Is Exempt

You do not have to meet the work requirement if you are:

• Pregnant, or eligible for postpartum coverage in your state.
• A parent, guardian, caretaker relative, or family caregiver of a child 13 or under, or of a person with a disability.
• Medically frail, or living with special medical needs that make it very hard to comply.
• A veteran with a total disability rating.
• A former foster care youth.
• American Indian or Alaska Native.
• Already meeting TANF work rules. The same goes for a household getting SNAP benefits, if you're not exempt from SNAP's work rules.
• In a drug or alcohol treatment or rehab program.
• An inmate of a public institution.

States may also offer short-term hardship exceptions. Examples: you're in the hospital or a nursing facility. You must travel far from home for serious medical care. You live in a county with a declared disaster, or one with high unemployment.

What Counts Toward the 80 Hours

If the rule applies to you, you can meet it in a month by any of these:

• Work, community service, or a work program — at least 80 hours.
• School at least half-time.
• Any mix of those, adding up to at least 80 hours.
• Earning at least 80 times the federal hourly minimum wage in the month ($580 in 2026). Seasonal workers get a different calculation.

How and When States Check

States must check when you apply and when your coverage renews. They can also choose to check more often between renewals. Some timing details worth knowing:

• Certain new applicants must show they met the rule for at least one month before the month they apply.
• Current enrollees must meet it for one or more months between renewals. Each state sets how many.
• States must reach out to people who could be subject to the rule before it starts.

How you'll report hours is up to your state. It could be an online portal, a paper form, or automatic data matching. Watch your mail and your state Medicaid account. Keep your address up to date. Find your agency in our State Medicaid Directory.

If You Get a Noncompliance Notice

What if your state can't confirm you met the rule? It must send you a notice first. You then get 30 calendar days to show that you complied — or that the rule doesn't apply to you at all. Don't ignore the notice. If you don't respond in time, your application can be denied or your coverage can end. If that happens, you can reapply at any time. You also keep your normal appeal rights when a state denies or ends coverage — see Your Rights.

Common Questions