Maryland

Maryland Medicaid and the new work rules

Medicaid (also called Medical Assistance) covers low-income adults ages 19 to 64, including the ACA expansion group, up to 138% of the federal poverty level. is run by Maryland Department of Health (MDH), Medicaid Administration — the Maryland Medical Assistance Program. Maryland expanded Medicaid on January 1, 2014, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 1,500,000 enrolled 320,000 in the expansion group

Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 320,000 people in Maryland. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

Maryland Health Connection says it will check existing state data sources first and will notify members directly if the work requirement applies to them; members will need to report their hours or qualifying activity at application and at each renewal. The state has introduced online self-screening tools to help members check in advance.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

152,000 people

That is the state's own estimate of how many will lose coverage.

The Maryland Department of Health's September 9, 2026 'Medicaid H.R. 1 Update' presentation projects about 152,000 of the state's ACA expansion adults could lose coverage once the work requirement takes effect, based on November 2025 enrollment data; an earlier estimate had been 115,000. Separately, the department estimates about 15,000 non-citizens will lose eligibility on October 1, 2026 for unrelated immigration-status reasons — a different population, not part of the 152,000 figure. The size of the group the work requirement reaches is itself reported two ways in official Maryland materials: a consumer notice (health.maryland.gov's 'changes.aspx' page) says about 300,000 Marylanders, while the state's work-requirements page and the September 2026 slide deck say more than 320,000; this file uses 320,000 because it is tied to a specific, more recent data date (November 2025).

Most of that is expected to be paperwork rather than people becoming ineligible. Which is the whole reason to sort out your address and your proof now rather than at the last minute.

February 2026 · already happened

CMS approved Maryland's Community Engagement-specific Advance Planning Document (CE-APD)

June 1, 2026 · already happened

CMS published the interim final rule implementing the federal Medicaid work requirement

September 2026 · already happened

Maryland Health Connection began mailing letters to members who will need to meet work requirements at their 2027 renewal

October 1, 2026

Certain non-citizens (some refugees, asylees, parolees, and trafficking/abuse victims) become ineligible for Medicaid

January 1, 2027

Work requirement, six-month renewals, and shortened retroactive coverage take effect

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Parents or caretakers of a child or of a person with a disability

Pregnant and postpartum individuals

People who are medically frail or have a serious or complex medical condition

People in an active drug or alcohol treatment program

People entitled to Medicare Part A or enrolled in Medicare Part B

Former foster youth under age 26

American Indians and Alaska Natives

Veterans with a total disability rating

People already meeting SNAP or TANF work requirements

People incarcerated or recently released from incarceration

Short-term hardship exemptions the state may grant: recent hospitalization or travel for necessary medical care, a county-level emergency or disaster, or high county unemployment

Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64138% of the poverty line

1 person: $1,835
2 people: $2,490
3 people: $3,142
4 people: $3,795
5 people: $4,449
6 people: $5,102
7 people: $5,755
8 people: $6,409

Parents and caretakers124-138% of the poverty line

1 person: $1,835
2 people: $2,490
3 people: $3,142
4 people: $3,795
5 people: $4,449
6 people: $5,102
7 people: $5,755
8 people: $6,409

Pregnant264% of the poverty line

2 people: $4,763
3 people: $6,011
4 people: $7,260
5 people: $8,511
6 people: $9,760
7 people: $11,009
8 people: $12,260

Source: Maryland Department of Health Medical Assistance Income Limits and Maryland Health Connection, both tables labeled 'Effective February 1, 2026'. A note on precision: Three discrepancies found in official Maryland sources, all published as-is rather than resolved by guesswork. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months Starting January 1, 2027, the roughly 320,000 adults in Maryland's ACA expansion group must renew their Medicaid coverage every six months instead of annually.

Back-dated coverage is changing on January 1 One month of retroactive coverage for Maryland's ACA expansion adults; two months for everyone else, including children, people 65 and older, and people with disabilities. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details Maryland Health Connection Free, and open all year The state's own work-rules page Read Maryland's guidance Updated as rules are finalized Talk to a person 1-855-642-8572 Maryland Health Connection Consumer Support Center (apply, check eligibility, report changes) HealthChoice Helpline (for members already enrolled who need help with their managed care plan) 1-800-284-4510

About the phone numbers: Both numbers were confirmed on current Maryland Department of Health and Maryland Health Connection pages as of this writing; call volume around renewal and work-requirement deadlines in 2026-2027 may mean longer hold times.

Deaf, hard of hearing or speech-impaired: Maryland Relay: 711.

EnglishSpanishAmharicArabicChineseFrenchGujaratiHaitian CreoleKoreanPortugueseRussianTagalogUrduVietnamese

Maryland Health Connection provides written notices and application help in English, Spanish, and eleven other languages, and its phone interpreter service covers more than 200 languages. Call 1-855-642-8572 to get help in your language; deaf and hard-of-hearing callers can use Maryland Relay at 711.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Maryland Department of Health (MDH), Medicaid Administration — the Maryland Medical Assistance Program · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.

"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 1-855-642-8572.

Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Maryland?

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 320,000 people in Maryland. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.

How many hours a month do I have to work?

80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.

Who is exempt from the work requirement in Maryland?

Exemptions include: Parents or caretakers of a child or of a person with a disability; Pregnant and postpartum individuals; People who are medically frail or have a serious or complex medical condition; People in an active drug or alcohol treatment program; People entitled to Medicare Part A or enrolled in Medicare Part B; Former foster youth under age 26; American Indians and Alaska Natives; Veterans with a total disability rating.

When do the Maryland work rules start?

January 1, 2027. Starting January 1, 2027, the roughly 320,000 adults in Maryland's ACA expansion group must renew their Medicaid coverage every six months instead of annually. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.

What is the income limit for Maryland Medicaid?

For adults 19 to 64, about $1,835 a month for one person and $6,409 for a household of 8.

How do I apply for Medicaid (also called Medical Assistance) covers low-income adults ages 19 to 64, including the ACA expansion group, up to 138% of the federal poverty level.?

Online at Maryland Health Connection, or by phone on 1-855-642-8572. It is free and there is no open-enrollment window — you can apply at any time of year.

How often do I have to renew Maryland Medicaid?

Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

DelawareThe new work rules Washington, D.C.The new work rules PennsylvaniaThe new work rules VirginiaThe new work rules West VirginiaThe new work rules

See all 50 states and Washington, D.C. on the map →

If you're one of Maryland's roughly 320,000 ACA expansion adults, Maryland Health Connection began mailing letters in September 2026 about the work requirement that starts January 1, 2027 — make sure your address and contact information on your account are current so you don't miss it, and check in advance using the state's online screening tool whether the requirement or an exemption applies to you.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to Maryland Health Connection →