The Medicaid work requirement, explained

Under H.R. 1, most adults covered through Medicaid expansion must show 80 hours a month of work, school, training or community service — or $580 a month in earnings — to keep coverage. Children, people 65 and older, pregnant women and most people covered because of a disability are not affected. Here is how it works, in plain language.

Deadline: January 1, 202743 states + D.C. affectedSome states start earlier

Who it applies to

Adults 19 to 64 covered through Medicaid expansion

The requirement reaches non-pregnant adults aged 19 to 64 who get Medicaid through the Affordable Care Act expansion group — the income-based coverage for adults that exists in 40 states and Washington, D.C. — plus a small number of similar groups covered under state waivers. CMS counts 43 states and D.C. that must implement it. People on Medicare are not included, and U.S. territories are not subject to the law.

If your state never expanded Medicaid and you are covered as a parent, a child, or because of age or disability, the federal work requirement does not reach you. Eight states that never expanded still have a waiver group that CMS says is covered — our guides for Tennessee, Wisconsin and Georgia explain who that catches.

Timing. States must have the requirement in place no later than January 1, 2027. Some are moving earlier: Arkansas began enforcing in 2026 and Iowa starts December 1, 2026. Your state's guide gives the local date.

What counts

80 hours a month — or $580 in earnings

In any month you must do at least 80 hours of one or a combination of:

Paid work
Community service or volunteering
A work program (job training, workforce programs)
Being enrolled in school or an educational program at least half-time

You also meet it automatically for a month in which you earn at least 80 times the federal minimum wage — $580 in 2026. Seasonal workers have a separate averaging rule. Hours can be combined across activities; they do not have to come from one job.

A new applicant generally has to show compliance for at least one month before the month of application. An existing member must show it for one or more months between renewals; states choose how many months they look back at, within federal limits, so the exact look-back differs by state.

Who is exempt

The federal list — states can add to it but not take from it

Pregnant or in the postpartum period
Medically frail or disabled, including serious mental illness or substance use disorder
Parents and caretakers of a child under 14, or of a person with a disability
American Indians and Alaska Natives
Veterans with a total disability rating
People already meeting SNAP or TANF work rules
People in substance-use treatment
People recently released from incarceration, and former foster youth under 26
Anyone enrolled in Medicare, or under 19 or over 64

States may also grant short-term hardship exceptions — for example during a hospital stay, when you must travel for medical care your community does not offer, in a county with unemployment at or above 8% (or 1.5 times the national rate), or during a declared disaster. Homelessness is not on the federal exemption list; a few states are addressing it through their own policies.

Exemptions are not always automatic. If you believe one applies to you, say so when you apply or renew and keep the paperwork that shows it — a doctor's letter, a child's birth certificate, a VA rating letter.

How it works

Verification, notice, 30 days, decision

The state checksAt application and at every renewal — and, if your state chooses, more often — the state checks whether you met the hours or an exemption, using payroll records and other data it already has before it asks you.

If it cannot verify, you get a noticeA notice of noncompliance tells you what is missing. You then have 30 calendar days to show you met the requirement or that it does not apply to you.

Then a decisionIf you do not respond or the state is not satisfied, an application can be denied or coverage ended. You can reapply at any time and will be assessed again.

Appeals still applyEvery denial or termination carries the right to a fair hearing. Ask for it before the end date on the letter and coverage usually continues while it is reviewed. Our guide to termination letters walks through it.

What to do now

Four things that take an afternoon

Confirm your address and phoneEverything about this requirement arrives by mail and text. Update them with your state agency today — the link is on your state's guide.

Find out if you are even in the groupCheck your coverage type. Parents, children, people 65+, and most people covered on disability grounds are not affected. Your state's guide explains which program names are the expansion group.

If an exemption fits, gather proofA doctor's letter for medical frailty, your child's birth certificate, your VA rating letter, or your SNAP case information. Have it ready before January.

If you are working or in school, keep recordsPay stubs, a letter from your employer, class schedules or enrollment letters, volunteer logs. States will use data they already hold first, but your records fill any gap.

Questions people are asking

Plain answers

Do I have to work 80 hours a month to keep Medicaid?Only if you are an adult aged 19 to 64 covered through Medicaid expansion and no exemption applies to you. Starting no later than January 1, 2027, that group must show 80 hours a month of work, school, training or community service, or earn at least $580 a month. Children, people 65 and older, pregnant women and most people covered because of a disability are not affected.

Does the Medicaid work requirement apply in every state?It applies in the 40 states and D.C. that expanded Medicaid, plus waiver groups in a few states that did not — 43 states and D.C. in total, by CMS's count. If your state never expanded Medicaid and you are covered as a parent, child, or because of age or disability, it does not reach you. Pick your state above to see its situation.

Who is exempt from the Medicaid work requirement?Pregnant and postpartum people; people who are medically frail or disabled; parents and caretakers of a child under 14 or of a person with a disability; American Indians and Alaska Natives; veterans with a total disability rating; people meeting SNAP or TANF work rules; people in substance-use treatment; and people recently incarcerated, among others. States can add exemptions but cannot remove the federal ones.

What counts toward the 80 hours?Paid work, community service or volunteering, a work or job-training program, or being enrolled at least half-time in school — alone or combined. Earning at least $580 in a month (80 times the federal minimum wage in 2026) also counts as meeting it.

What happens if I miss a month?The state sends a notice of noncompliance and gives you 30 calendar days to show you met the requirement or are exempt. If you do not, your application can be denied or your coverage ended. You can reapply at any time, and you can request a fair hearing on any termination.

When does the work requirement start?States must have it in place no later than January 1, 2027. A few are earlier: Arkansas began enforcing in 2026 and Iowa starts December 1, 2026. Your state's guide shows its date and how it is counting the first months.

MedicaidMatters is not a government website and is not affiliated with CMS or any state Medicaid agency. We never ask for your Social Security number, case number, or immigration documents. Every action on this page links to an official government site.

The rules are national. The numbers are local.

Your state's guide has the income table, the renewal process, the exemptions as your state applies them, and the phone number to call.

Find your state →

Looking for your own state? See when the work rules start in every state → — start dates for all 50 states and Washington, D.C., including the three already enforcing them.