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Rhode Island Medicaid and the new work rules
Rhode Island Medicaid covers adults through several separate pathways, and which one you are in decides whether the new federal work requirement reaches you. The ACA expansion group — what the state calls "Medicaid Expansion" or "expansion adults" — covers adults ages 19 through 64 who are not pregnant, are not a parent or caretaker of a minor child, and do not have Medicare. On the state's current guidance that is the only group the work requirement applies to. Parents and caretaker relatives living with a child are covered separately through RIte Care, people who are aged, blind, or disabled are covered through Rhody Health Partners and the non-MAGI pathways, and adults who need long-term services and supports are covered under the state's long-term care rules. is run by Rhode Island Executive Office of Health and Human Services (EOHHS) runs the Medicaid program and sets policy. The Department of Human Services (DHS) takes and processes applications and handles renewals, and HealthSource RI — the state's own health insurance marketplace — helps with health coverage applications and with moving to a private plan if Medicaid ends. Consumer-facing Medicaid information lives at staycovered.ri.gov; member accounts live at healthyrhode.ri.gov. Rhode Island 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.
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 109,333 people in Rhode Island. 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.
Rhode Island intends to confirm as much as it can from data it already holds before asking anyone for paperwork. For qualifying activity it will use state employment and wage records to check the $580-a-month earnings test and the 80-hour work test, with self-attestation available for community service, work program participation and education; the state expects school and training enrollment data to be usable by mid-2027. For exemptions it will use Social Security Administration data for age and Medicare, its RI Bridges eligibility system for mandatory categorically needy status, caretaker status, TANF and SNAP, Department of Corrections data for recent incarceration, DCYF data for former foster youth, and Medicaid claims data for substance use disorder treatment and for medical frailty. Veteran total disability status requires manual verification, and pregnancy, postpartum status and American Indian or Alaska Native status can be self-attested. If the state has enough on file, coverage renews automatically and the member gets a Benefits Decision Notice; if not, the member gets a yellow renewal notice plus a white notice asking for documents.
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.
That is the state's own estimate of how many will lose coverage.
Rhode Island's own figure, and it has been remarkably stable across three state documents. EOHHS's November 2025 caseload testimony walked through the arithmetic: about 90,000 people sit in the eligibility groups the state initially believed were in scope; after using claims data as a proxy for who is likely exempt and income and SNAP or TANF participation as a proxy for who is likely already compliant, EOHHS expected about 32,000 people to be actually subject to the requirement, and assumed 75% of those — approximately 24,600, 'nearly all from the expansion population group' — would be at risk of disenrollment. The 75% assumption came from the experience of the two states that have previously implemented work requirements. The fiscal table put it at 24,630 people and a $49.7 million expenditure reduction in fiscal 2027, of which $5.0 million is state general revenue, split 24,460 expansion adults and 170 RIte Care parents. The House Fiscal Advisor's March 25, 2026 staff presentation repeated those figures. The Federal Compliance Advisory Group's November 2025 report at-a-glance rounded the same estimate: 'Impact: Roughly 24,000 could lose coverage; heavy administrative buildout required.' Against the 109,333 expansion adults EOHHS counted in fiscal 2025, that is a little over one in five. EOHHS cautioned that its estimates were 'not indicative of final policy decisions' and did not account for federal guidance that had not yet been issued — the interim final rule came six months later.
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.
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.
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
- $1,835
- 2 people
- $2,489
- 3 people
- $3,142
- 4 people
- $3,795
- 5 people
- $4,448
- 6 people
- $5,101
- 7 people
- $5,755
- 8 people
- $6,408
Parents and caretakers133% of the poverty line
- 2 people
- $2,489
- 3 people
- $3,142
- 4 people
- $3,795
- 5 people
- $4,448
- 6 people
- $5,101
- 7 people
- $5,755
- 8 people
- $6,408
Pregnant253% of the poverty line
- 1 person
- $3,431
- 2 people
- $4,653
- 3 people
- $5,874
- 4 people
- $7,095
- 5 people
- $8,316
- 6 people
- $9,537
Source: Rhode Island Department of Human Services, '2026 Monthly Poverty Guidelines For Medicaid and All DHS Programs (except SNAP),' revised February 16, 2026; income thresholds and ceilings from EOHHS regulation 210-RICR-30-00-1, § 1.6(B), 'Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways'. A note on precision: Two small things worth flagging. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
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.
About the phone numbers: The DHS Call Center is open Monday, Tuesday, Thursday and Friday from 8:30 a.m. to 3 p.m., except holidays — it is closed Wednesdays, which catches people out. The line has a menu: press 4 to report a change, press 3 for forms and applications, press 5 for general information, and press 6 to speak to a staff member. HealthSource RI's Contact Center is open Monday through Friday from 8 a.m. to 6 p.m., with extended hours during open enrollment, and also offers live web chat in English and Spanish. All numbers were confirmed on current dhs.ri.gov, eohhs.ri.gov, staycovered.ri.gov and healthsourceri.com pages.
Deaf, hard of hearing or speech-impaired: Dial 7-1-1 for Rhode Island Relay if you are deaf or hard of hearing. HealthSource RI also has a direct TTY line at 1-888-657-3173.
Rhode Island publishes its Medicaid work requirement materials — the FAQ, the flyer, and the actual notice and text message sent to members in August 2026 — in twelve languages: English, Spanish, Portuguese, Arabic, Cape Verdean Creole, French, Haitian Creole, Khmer, Laotian, Russian, Simplified Chinese and Swahili. The broader flyer on all the federal Medicaid changes adds Dari and Pashto, for fourteen. The Department of Human Services publishes its customer resource guide, which explains the best way to reach the agency for each kind of question, in English, Spanish and Portuguese. More than 100 health coverage navigators work across the state and many are fluent in languages other than English; United Way of Rhode Island's 2-1-1 line will connect you to one near you, and HealthSource RI runs live web chat in English and Spanish. If you are deaf or hard of hearing, dial 7-1-1 for Rhode Island Relay, or use HealthSource RI's TTY line at 1-888-657-3173.
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.
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.
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.
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.
Where you live in this state changes what coverage is worth. As of September 30, 2026, Rhode Island had 17 designated primary care Health Professional Shortage Areas covering 257,218 people, with 74.3% of the state's primary care need met and 22 more practitioners needed to clear the designations. The shape of those designations is the telling part: only one is a geographic-area designation, while six are population-group designations and ten are facility designations. In other words, federal shortage designations in Rhode Island are overwhelmingly about who you are and which clinic you depend on rather than where in the state you live — a low-income population group inside a city that is otherwise well supplied with doctors, or a specific community health center carrying more patients than it has clinicians. Behavioral health is tighter than primary care: 16 mental health shortage designations cover 185,974 people with only 37.4% of need met, and again none of them is a geographic-area designation. Dental care is the one area with any geographic spread, with 3 geographic-area designations among 14 total, covering 411,900 people at 45.4% of need met. Providence, where the state reported 31,371 of its 109,333 expansion adults live, is also where the non-citizen eligibility change landed hardest — 1,886 of the 3,563 affected Rhode Islanders. HRSA Bureau of Health Workforce, 'Designated HPSA Quarterly Summary,' fourth quarter of fiscal year 2026, data as of September 30, 2026 (Tables 3, 4 and 5); expansion-adult and non-citizen geographic breakdowns from EOHHS's August 2026 'Federal Changes Impacting RI Medicaid' webinar slides.
The requirement also reaches a separate waiver group here
Rhode Island is one of eight states CMS named for an extra 1115 waiver population.
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.
Questions people ask about this
Do the new Medicaid work rules apply to me in Rhode Island?
How many hours a month do I have to work?
Who is exempt from the work requirement in Rhode Island?
When do the Rhode Island work rules start?
What is the income limit for Rhode Island Medicaid?
How do I apply for Rhode Island Medicaid covers adults through several separate pathways, and which one you are in decides whether the new federal work requirement reaches you. The ACA expansion group — what the state calls "Medicaid Expansion" or "expansion adults" — covers adults ages 19 through 64 who are not pregnant, are not a parent or caretaker of a minor child, and do not have Medicare. On the state's current guidance that is the only group the work requirement applies to. Parents and caretaker relatives living with a child are covered separately through RIte Care, people who are aged, blind, or disabled are covered through Rhody Health Partners and the non-MAGI pathways, and adults who need long-term services and supports are covered under the state's long-term care rules.?
How often do I have to renew Rhode Island Medicaid?
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.
If you are one of Rhode Island's roughly 109,000 expansion adults — ages 19 to 64, not pregnant, no minor child at home, no Medicare — the first renewals under the new work rules land on March 31, 2027, with notices mailed around February 1, so the state will be writing to you in a little over three months.
Log in to healthyrhode.ri.gov now and make sure your mailing address, cell phone number and email are right, then run the state's anonymous screener at staycovered.ri.gov/work, which needs no login and records nothing, to see whether you are already exempt. Remember that you only need to meet the requirement in one month out of every six.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to HealthyRhode (Rhode Island's online application and member account) →