Since October 1, some lawfully present immigrants no longer qualify for Medicaid.

A federal change under H.R. 1 ended Medicaid and CHIP eligibility for many people who are in the United States legally — including refugees and people granted asylum who don't yet have a green card, humanitarian parolees, survivors of trafficking, and people with Temporary Protected Status. Emergency Medicaid still covers emergencies regardless of status, and lawfully residing children and pregnant people keep coverage in many states. If you were covered and your notice says otherwise, read your state's guide below and call the number on it.

All states Medicaid work requirements, state by state

All 50 states and D.C.

Medicaid work requirements, state by state

The new federal work requirement reaches most adults covered through Medicaid expansion. Here is when it starts in every state, who is excluded from it, what counts toward the 80 hours, and the things most commonly got wrong about it.

In most of the country the new Medicaid work requirement starts January 1, 2027. It applies to adults aged 19 to 64 who are covered through Medicaid expansion, and asks them to show 80 hours a month of work, study, job training, volunteering, or any combination — or earnings of at least $580 in the month.

Three states are already enforcing it: Arkansas, Montana and Nebraska. Iowa starts earlier than the federal date, on December 1, 2026. seven states never expanded Medicaid, so the requirement does not reach most adults there at all — though three states that also never expanded, Georgia, Tennessee and Wisconsin, are covered anyway through a waiver.

Roughly a quarter of the people the rule reaches are expected to be excluded from it outright, and the states already running it report that the people losing coverage are overwhelmingly losing it for not returning paperwork rather than for not working.

Every state

When the work rules start where you live

All 50 states and Washington, D.C. Click your state for the income limits, the full exemption list, the phone number to call, and what the state has actually published.

Status as of October 1, 2026. Source: each state's own published material, with the federal rule at 91 Fed. Reg. 33348.
StateStatusStartsWhat that means
AlabamaDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
AlaskaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
ArizonaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
ArkansasBeing enforced nowSince July 1, 2026Checks and notices are running; penalties begin January 1, 2027.
CaliforniaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
ColoradoJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
ConnecticutJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
DelawareJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
FloridaDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
GeorgiaThrough PathwaysAlready requiredGeorgia's own Pathways program already conditions coverage on activity.
HawaiiJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
IdahoJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
IllinoisJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
IndianaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
IowaStarts earlyDecember 1, 2026The state set its own date ahead of the federal deadline.
KansasDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
KentuckyJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
LouisianaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MaineJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MarylandJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MassachusettsJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MichiganJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MinnesotaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MississippiDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
MissouriJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
MontanaBeing enforced nowSince July 1, 2026Enforced now. Coverage can be lost over it today.
NebraskaBeing enforced nowSince May 1, 2026Enforced now. Coverage can be lost over it today.
NevadaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
New HampshireJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
New JerseyJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
New MexicoJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
New YorkJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
North CarolinaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
North DakotaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
OhioJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
OklahomaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
OregonJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
PennsylvaniaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
Rhode IslandJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
South CarolinaDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
South DakotaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
TennesseeThrough a waiverJanuary 1, 2027Never expanded Medicaid, but CMS named a waiver group that is covered.
TexasDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
UtahJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
VermontJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
VirginiaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
WashingtonJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
Washington, D.C.January 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
West VirginiaJanuary 1, 2027January 1, 2027The federal deadline, which applies unless the state moved earlier.
WisconsinThrough a waiverJanuary 1, 2027Never expanded Medicaid, but CMS named a waiver group that is covered.
WyomingDoesn't reach most adultsNot applicableNever expanded Medicaid and has no qualifying waiver group.
What counts

What counts toward the 80 hours

The requirement is not a job requirement. Federal law lists several ways to meet it, and you can combine them.

Paid work, including self-employment and work in exchange for goods or services
Unpaid work
Community service with a structured program, including court-ordered service
A work program such as one under WIOA, the Trade Act, or SNAP employment and training
Enrollment in an educational program at least half-time
Any combination of the above adding up to 80 hours
Earning at least $580 in the month, which satisfies it on its own
For seasonal workers, an average monthly income over the previous six months
Why the figure is $580 and not your state's minimum wage

The income test is 80 hours multiplied by the federal minimum wage of $7.25, and federal law does not let a state substitute its own higher minimum wage. The practical consequence is in your favor: if you earn more than $7.25 an hour, you reach $580 in fewer than 80 hours of work. Tipped wages cannot be used for this calculation.

Commonly misunderstood

Four things that are widely repeated and not true

“A court blocked the rule.”

It did not. Twenty-six states and governors sued in Commonwealth of Massachusetts v. Oz, and the court denied their request for a preliminary injunction on July 29, 2026 — on whether the states would suffer irreparable harm, not on whether the rule is lawful. Summary judgment is heard October 20, 2026. The rule is in force and no part of it is stayed.

“Being homeless exempts you.”

There is no homelessness exemption, and states are not permitted to add one. CMS considered it and declined, reasoning that homelessness is not itself a medical condition. Many people who are homeless will qualify under the medically frail exclusion instead — through a substance use disorder or a disabling mental disorder — so the route exists, but you have to be found to meet it.

“Your state can add its own exemptions.”

It cannot. The list of excluded people is closed, and federal law expressly forbids waiving the requirement at all. What a state can choose is whether to offer the short-term hardship exceptions — those are optional, so they exist in some states and not others.

“It only matters if you aren't working.”

The evidence so far says the opposite. In Nebraska, the first state to enforce it, the state's own figures show 84% of application denials and 92% of renewal closures were for failing to return requested information — not for failing to work enough. Keeping your address current with the state and opening its mail is the single most protective thing you can do.

Questions

Questions people ask about this

When do Medicaid work requirements start?
January 1, 2027 in most states. Three states are already enforcing them: Nebraska since May 1, 2026, Montana since July 1, 2026, and Arkansas, which began a soft launch on July 1, 2026 with penalties starting January 1, 2027. Iowa starts December 1, 2026.
Which states do not have Medicaid work requirements?
Seven states never expanded Medicaid, so the requirement does not reach most adults there: Alabama, Florida, Kansas, Mississippi, South Carolina, Texas and Wyoming. Three other states that also never expanded — Georgia, Tennessee and Wisconsin — are covered anyway, because CMS identified groups in their section 1115 waivers that the rule reaches.
How many hours a month do I have to work?
80 hours a month. Work is not the only way to meet it: study at least half-time, job training, community service and volunteering all count, and you can combine them. Earning at least $580 in the month satisfies it on its own, and seasonal workers can use an average of their income over the previous six months.
Does the work requirement apply to me if I am already working?
You still have to be able to show it. Most states check their own records first and clear most people automatically — Alaska expects to clear 69% that way — but if the state cannot verify your hours it will write to you, and you then have 30 days from receiving that notice to respond. Ignoring it is how working people lose coverage.
Has a court stopped the Medicaid work requirement?
No. A coalition of 26 states and governors sued CMS in Commonwealth of Massachusetts v. Oz, and on July 29, 2026 the court denied their request for a preliminary injunction. That decision turned on irreparable harm rather than the merits, and summary judgment is scheduled to be heard on October 20, 2026. The rule is in force today.