Massachusetts

Massachusetts Medicaid and the new work rules

MassHealth CarePlus is run by Massachusetts Executive Office of Health and Human Services (EOHHS), Office of Medicaid — MassHealth. Massachusetts 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 1,873,597 enrolled 344,092 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 344,092 people in Massachusetts. 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.

MassHealth plans to clear as many people as it can without asking them for anything. It is matching against Department of Revenue wage records, DTA benefit records, Veterans Affairs data, the National Student Clearinghouse, and its own medical claims data for medical frailty. If the data answers the question, you will be renewed and told so. If it does not, your renewal notice arrives in a blue envelope, and that envelope is the one that asks you to act.

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.

175,000 people

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

MassHealth's own published estimate of how many people will lose coverage because of the work requirement and six-month renewals together. The state separately estimates that up to 300,000 Massachusetts residents could lose health insurance across all of the 2025 federal law's changes, and that about $3.5 billion in federal health care funding a year will leave Massachusetts once the law is fully in effect. A reader who sees the 360,000 figure in the Governor's August 2026 announcement should know it measures something different — the number of people who may have to report, not the number expected to lose coverage.

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.

June 3, 2026 · already happened

CMS published the interim final rule setting how states must run the requirement, and named Massachusetts as one of eight states that must also apply it to specific 1115 waiver populations

June 29, 2026 · already happened

Massachusetts led 25 states and the District of Columbia in suing CMS over the rule's narrowed definition of medical frailty

July 29, 2026 · already happened

A federal judge in Boston declined to pause the rule, but only on the question of harm to state budgets. The case continues on the merits, on an expedited schedule meant to finish before January 1, 2027

August 11, 2026 · already happened

Governor Healey launched a statewide campaign to help members keep coverage, with $10 million going to Health Care For All and about 50 community organizations

August 2026 · already happened

MassHealth began notifying members who may be affected, by mailed notice, text, email and robocall

September 17, 2026 · already happened

CMS approved MassHealth's plan to close the waiver pathway that gives automatic MassHealth to people receiving TAFDC or EAEDC cash assistance

October–December 2026

MassHealth stops enrolling new people through the TAFDC and EAEDC pathway; people in those programs are told to apply for MassHealth directly instead

January 1, 2027

The requirement takes effect. Six-month renewals begin for the same group, and retroactive coverage shortens

Your first renewal in 2027

This is when the requirement actually reaches you if you are already a member. Renewals are staggered across the year, so your date depends on your case

2028

Self-attestation narrows. In 2027 you can mostly state that you comply or are excused; from 2028 more members will have to produce documents

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.

Pregnant, or less than 12 months postpartum, whatever the outcome of the pregnancy

A parent or guardian caring for a child younger than 14, or for a person with a disability

A caretaker relative — related to and the primary caregiver for a child under 14, or a person with a disability, who lives with you

A family caregiver — you live with or are related to a child under 14 or a person with a disability and give regular care, or you give at least 80 hours of care a month

Eligible for Medicare Part A, or enrolled in Medicare Part B

Under 26 and on Medicaid when you aged out of foster care

American Indian or Alaska Native, in the categories federal law specifies

Living with a disability that seriously limits your ability to do a daily task such as bathing, dressing or eating without help

Living with an alcohol or drug addiction

Living with a serious mental health condition, such as schizophrenia or major depression

Living with a serious or complex condition, such as cancer or heart failure, that needs frequent medical care

Blind, or disabled under Social Security rules

Receiving TAFDC cash help and meeting the TAFDC work rules

A veteran with a total disability rating from the Department of Veterans Affairs

In a household that gets SNAP, where DTA has told you or someone in your household you must meet work rules

Taking part in certain substance use disorder treatment and rehabilitation programs

An inmate of a public institution, or released from one within the previous three months

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 64133% of the poverty line

1 person: $1,769
2 people: $2,399
3 people: $3,028
4 people: $3,658
5 people: $4,288
6 people: $4,917

Parents and caretakers133% of the poverty line

1 person: $1,769
2 people: $2,399
3 people: $3,028
4 people: $3,658
5 people: $4,288
6 people: $4,917

Pregnant200% of the poverty line

1 person: $2,660
2 people: $3,607
3 people: $4,554
4 people: $5,500
5 people: $6,447
6 people: $7,394

Source: 2026 MassHealth Income Standards and Federal Poverty Guidelines (document code DG-FPL_2026-03), effective March 1, 2026. A note on precision: Massachusetts publishes its adult limit as 133% of the poverty line, not the 138% figure used in most national coverage. 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 From January 1, 2027 the same group of adults 19 through 64 renews every six months instead of every year, which doubles the number of chances to be dropped for a missed letter; people who are pregnant, less than 12 months postpartum, living with a child under 19, blind or disabled under Social Security rules, and certain American Indians and Alaska Natives are not affected.

Back-dated coverage is changing on January 1 One month for adults in the expansion group, which in Massachusetts means CarePlus. Two months for children, people 65 and over, and people covered on grounds of disability. MassHealth states both figures on its own federal-updates page. 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 the MassHealth application page The online application runs through an MA Login account at mahix.org. The state's own work-rules page Read Massachusetts's guidance Updated as rules are finalized Talk to a person (800) 841-2900 Self-service 24 hours a day in English and Spanish; other services Monday–Friday, 8am–5pm Massachusetts Health Connector (877-MA-ENROLL), Mon–Fri 8am–6pm (877) 623-6765 for marketplace plans, not MassHealth

About the phone numbers: Only the self-service menu runs around the clock, and only in English and Spanish. To reach a person you need to call Monday to Friday between 8am and 5pm. Most MassHealth pages give the TTY number as 711; two pages give (800) 497-4648 instead, and both are state-published, so either should work.

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

Free interpreter line: Interpretation is free. Ask for it when you call (800) 841-2900 — MassHealth contracts for interpretation in roughly 150 languages and for sign language interpreters.

EnglishSpanishPortuguese (Brazilian)ChineseHaitian CreoleVietnameseRussianArabicKhmerFrenchItalianKoreanGreekPolishHindiGujaratiLao

MassHealth publishes its "we will translate this for you, free" notice in sixteen languages, but the paper application itself comes in only six: English, Spanish, Simplified Chinese, Brazilian Portuguese, Vietnamese and Haitian Creole. The MyServices online account is available in those same six. If your language is not one of them, call (800) 841-2900 and ask for an interpreter before you start the form — MassHealth contracts for phone interpretation in roughly 150 languages and dialects, and for sign language interpreters, at no cost to you. Braille and large print are available on the same phone number.

If a letter arrives

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

67.0% of the coverage losses recorded in Massachusetts were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. From January 1, 2027 that matters more, not less.

Massachusetts Executive Office of Health and Human Services (EOHHS), Office of Medicaid — MassHealth · 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 (800) 841-2900.

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.

Procedural disenrollment · CMS

67.0%

Of people who lost coverage here, this share lost it over paperwork rather than eligibility.

Open every letter. Keep your address current with the agency.

Payment error rate · CMS

7.1%

Records here are relatively accurate, so treat a notice as real rather than assuming a mistake.

Quintile 4 of 5.

Primary care supply · America's Health Rankings

400 /100k

Provider supply here is around the national middle.

Book an appointment before you need one, not when you do.

One more group

The requirement also reaches a separate waiver group here

Massachusetts is one of eight states CMS named for an extra 1115 waiver population.

Who that is. Two groups inside the MassHealth 1115 demonstration — adults living with HIV who are covered by MassHealth Family Assistance with income above 133% and up to 200% of the poverty line, and people who get MassHealth automatically because they receive TAFDC or EAEDC cash assistance from the Department of Transitional Assistance.

The new work rules were written for the ACA expansion group, which in Massachusetts means MassHealth CarePlus. But MassHealth has run an unusually broad 1115 demonstration since 1997, and it covers some people who are not in the expansion group on paper yet look very similar to it. CMS went through those demonstrations and named eight states that must apply the work rules to specific waiver populations as well. Massachusetts is one, and CMS named two MassHealth groups. The first is people living with HIV who get MassHealth Family Assistance because their income is above the CarePlus cutoff of 133% of the poverty line but no higher than 200% — people who would be on CarePlus if they earned less. The second is people who are enrolled in MassHealth automatically because DTA approved them for TAFDC or EAEDC cash assistance, rather than because MassHealth looked at their income. Massachusetts decided it could not run the work rules through the old computer system that handles the cash-assistance pathway, so instead of applying them there it asked CMS for permission to close that pathway altogether. CMS approved that on September 17, 2026. If you have MassHealth because you get TAFDC or EAEDC, your coverage is not ending on its own, but the automatic link between the two is — MassHealth will renew you onto regular MassHealth, and it is urging people in this group to apply directly in 2026 rather than wait. If you have Family Assistance because you are HIV positive, expect the work and education rules to reach you the same way they reach CarePlus members.

Someone in either group has every reason to assume the news coverage about work requirements is about somebody else. Neither group is called 'expansion', and the cash-assistance group never went through a MassHealth income determination at all.

One of the two is being closed rather than kept. MassHealth asked CMS to terminate Expenditure Authority 5 and the matching Special Term and Condition 4.5, the authority that lets it enroll TAFDC and EAEDC recipients automatically. In its own filing, MassHealth said the legacy eligibility system holding this population cannot support the work requirement, that eligibility would have to be rebuilt in its Integrated Eligibility System, and that people in this group do not submit the information needed to check compliance — so it could not keep the waiver authority and meet the federal law at the same time.

MassHealth stops enrolling new people through the pathway around October to December 2026. Existing members are renewed on a rolling basis, with MassHealth sending them an application and checking whether they qualify on another basis before anything is terminated. Anyone found ineligible gets a notice with appeal rights, and coverage continues during an appeal filed before the date of action.

MassHealth's September 2026 request to extend the demonstration for 2028 through 2032 asks to keep covering HIV-positive people above the CarePlus income limit, so this pathway is not being closed. No MassHealth page found states specifically how the work and education requirement will be applied to it.

CMS has said it is working with some of the states whose named waiver groups are small to see whether an exception is possible, so the details here could still move. What is settled is that CMS listed Massachusetts, and that Massachusetts has already acted on half of the listing by closing the cash-assistance pathway.

If you are covered one of these ways rather than through the ordinary expansion group, the rules above still reach you. Don't assume otherwise because your coverage has a different name.

CMS interim final rule, 91 Fed. Reg. 33353–33354 (June 3, 2026); the CMS slide deck naming eight states and 13 demonstrations, reported by Georgetown CCF on July 16, 2026 and by KFF on July 24, 2026; MassHealth 1115 Transition and Phase-Out Plan and cover letter of August 27, 2026, approved by CMS September 17, 2026

Common questions

Questions people ask about this

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

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 344,092 people in Massachusetts. 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 Massachusetts?

Exemptions include: Pregnant, or less than 12 months postpartum, whatever the outcome of the pregnancy; A parent or guardian caring for a child younger than 14, or for a person with a disability; A caretaker relative — related to and the primary caregiver for a child under 14, or a person with a disability, who lives with you; A family caregiver — you live with or are related to a child under 14 or a person with a disability and give regular care, or you give at least 80 hours of care a month; Eligible for Medicare Part A, or enrolled in Medicare Part B; Under 26 and on Medicaid when you aged out of foster care; American Indian or Alaska Native, in the categories federal law specifies; Living with a disability that seriously limits your ability to do a daily task such as bathing, dressing or eating without help.

When do the Massachusetts work rules start?

January 1, 2027. From January 1, 2027 the same group of adults 19 through 64 renews every six months instead of every year, which doubles the number of chances to be dropped for a missed letter; people who are pregnant, less than 12 months postpartum, living with a child under 19, blind or disabled under Social Security rules, and certain American Indians and Alaska Natives are not affected. 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 Massachusetts Medicaid?

For adults 19 to 64, about $1,769 a month for one person and $4,917 for a household of 6.

How do I apply for MassHealth CarePlus?

Online at the MassHealth application page, or by phone on (800) 841-2900. 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 Massachusetts 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.

ConnecticutThe new work rules New HampshireThe new work rules New YorkThe new work rules Rhode IslandThe new work rules VermontThe new work rules

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

Your first renewal in 2027 is the moment the new work and education rules reach you, and if MassHealth cannot confirm from its own records that you are working or excused, that renewal arrives in a blue envelope.

Make sure MassHealth has your current mailing address, cell number and email today, because the blue envelope is the one thing standing between you and losing coverage over paperwork.

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

Go to the MassHealth application page →