Medicaid now requires proving 80 hours a month of work, school or volunteering
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Adults 19β64 covered through Medicaid expansion must document at least 80 hours a month of work, job training, school, or community service, or an income of at least the equivalent, to enroll and to stay enrolled. States check this at application and at every renewal, with a look-back of one to three months. Exemptions exist for parents of children 13 and under, pregnant women, people who are "medically frail," and a few other groups, but you have to be identified or prove it.
The Congressional Budget Office expects about 5 million people to lose coverage from this provision alone, and the federal rule implementing it estimates 2.3 million lose Medicaid in the first year. Arkansas tried this in 2018: 18,000 people lost coverage in months, most of them working or exempt, and employment did not rise. Georgia's version, running since 2023, had about 19,000 people enrolled in mid-2026 after spending roughly $166 million, most of it on administration. Nebraska, the first state to enforce the new federal rule, began removing people in August 2026. If your hours vary, you work cash jobs, you are a caregiver, or you miss a notice, you can lose coverage while still eligible.
- Make sure your state Medicaid agency has your current address, phone and email. Most coverage losses start with a missed letter.
- If you have a disability or serious condition, ask your doctor now to document how it limits your ability to work; the federal rule says a diagnosis alone is not enough.
- Keep pay stubs, class schedules, or volunteer logs each month so you can show 80 hours when asked.
Requirement for states to establish Medicaid community engagement requirements
Passed by Congress and signed. Opens the enacted text at that section.
- Official Medicaid community engagement requirement: interim final rule fact sheet (Centers for Medicare & Medicaid Services)
- Nonpartisan Medicaid work requirement rules: exemptions explained (KFF Health News)
- Nonpartisan A closer look at the work requirement provisions (KFF)
- Nonpartisan Medicaid work requirements tracker (KFF)
- Nonpartisan Nebraska becomes first state to disenroll Medicaid recipients under new work requirements (Nebraska Public Media)
- Nonpartisan Nebraska's Medicaid work requirement: fears of losing coverage (KFF Health News)
- Nonpartisan Montana Medicaid work requirements loom; questions remain (Montana Free Press)
- Nonpartisan What we know from state work-requirement experience (KFF)
- Nonpartisan Medicaid work requirements: results from the first year in Arkansas (New England Journal of Medicine)
- Nonpartisan New evidence confirms Arkansas's Medicaid work requirement did not boost employment (Urban Institute)
- Nonpartisan Georgia Pathways data tracker (GeorgiaPathways.org)
- Nonpartisan Georgia's Medicaid work-requirement experiment: high cost, low enrollment (KFF Health News)
- Conservative Medicaid work requirements are a short-term fix to a long-term problem (Reason)