New Medicaid Work Requirements: How They Affect You

The new Medicaid work requirements could change what it takes to keep your coverage. You already know you qualify for Medicaid. What you may not know is that a federal law signed in 2025 adds a new step starting in 2027, and most people on Medicaid haven't heard about it yet.

Here's the good news: you still have time to get ready. This article walks you through what changed, who it affects, and what you can do now.

What are the new Medicaid work requirements?

On July 4, 2025, the federal government signed a new law that added work requirements to Medicaid for the first time. Until now, Medicaid eligibility was based mainly on income and other facts about your life, like a disability or a pregnancy. The new law adds a different kind of rule.

Starting January 1, 2027, most adults ages 19 to 64 who get Medicaid through the Affordable Care Act expansion will need to complete at least 80 hours per month of one of these activities to keep their coverage:

• Working a paid job
• Job training or a work program
• School or an education program (at least half time)
• Community service or volunteering

You can mix these activities to reach 80 hours. According to the Centers for Medicare & Medicaid Services, you can also meet the rule by earning at least $580 per month, which is 80 hours at the federal minimum wage.

The law is sometimes called the "community engagement" requirement. It's the same thing as the work requirement. States have to start it by January 1, 2027, though some may start sooner.

Most people haven't heard about this yet

If this is the first you're hearing of it, you're not alone. A 2025 survey by The Health Management Academy found that about 55% of Medicaid enrollees were completely unaware of the coming work requirements. Another 27% had heard something but didn't know the details.

That's a problem, because the people who lose coverage under rules like this often lose it for paperwork reasons, not because they didn't qualify. Knowing now gives you a head start. You have time before the rules begin to figure out where you stand and what you'll need to show.

Who is exempt from the work requirements?

Many people won't have to meet the 80-hour rule at all. The law lists groups that are exempt, which means the requirement doesn't apply to them. According to KFF, exempt groups include:

• People with a disability or a serious medical condition
• People who are pregnant or recently gave birth
• Parents and caregivers of a child age 13 or younger, or of a person with a disability
• People under age 19 or enrolled in Medicare
• People in certain other groups, such as foster youth and those recently released from incarceration

If you fall into one of these groups, you may not need to report any work hours. The catch is that you'll likely have to prove your exemption. So it helps to know which group you're in and what documents back it up, well before 2027.

Your information will be checked twice a year

The new law changes one more thing worth knowing. Right now, most states check Medicaid eligibility once a year. Starting with renewals on or after January 1, 2027, states will check twice a year, or every six months.

According to the federal Medicaid agency, this means you'll need to re-verify your information more often than before. More check-ins means more chances to miss a notice or a deadline. So keeping your contact information current with your state Medicaid office matters more than it used to.

Watch your mail and email. States are required to send notices about these changes, and missing one could put your coverage at risk even if you still qualify.

What you can do right now

You don't need to take action with your state today. The rules don't start until 2027. But you can prepare, and the simplest first step is to get a clear picture of your benefits and where you stand.

Knowing whether you're likely exempt, what hours might count, and which documents you'll need takes the worry out of 2027. If you've had a change in income or a settlement that affects Medicaid, that's worth sorting out now too. A benefits review pulls all of it together.

Your next step: Run Turnout's free benefits scan to see your full benefits picture and find out how these changes apply to you. We know the system, so you can stay ahead of any change to your coverage before it puts anything at risk.

FAQs

Do I have to start working 80 hours a month right now?

No. The work requirements don't start until January 1, 2027, and some states may begin a little sooner. You have time to learn whether the rule even applies to you and to gather any documents you might need.

What counts toward the 80 hours per month?

Several activities count. You can work a paid job, take part in job training or a work program, attend school at least half time, or do community service. You can combine them to reach 80 hours. Earning at least $580 in a month also meets the rule.

Does the work requirement apply to everyone on Medicaid?

No. It applies mainly to adults ages 19 to 64 who get Medicaid through the Affordable Care Act expansion. People with a disability, pregnant women, caregivers of young children, people on Medicare, and several other groups are exempt.

What happens if I don't meet the requirement?

If you're not exempt and you don't report 80 hours of qualifying activity, you could lose your Medicaid coverage. That's why it helps to know now whether the rule applies to you and to keep your information current with your state Medicaid office.

How often will my Medicaid be checked now?

Starting with renewals on or after January 1, 2027, states will check eligibility twice a year instead of once a year. You'll need to re-verify your information every six months, so watch for notices from your state.