Medicaid work rules: what to expect and how to stay covered
Many adults 19 to 64 will need to show 80 hours of work, school or volunteering. Who's exempt and how to report.
What are Medicaid work requirements?
Congress passed legislation in 2025 requiring states to implement community engagement conditions (also called work requirements) for adults aged 19 to 64 who receive Medicaid through the ACA expansion. Starting December 31, 2026, these adults must demonstrate at least 80 hours per month of qualifying activities to keep their coverage.
What counts as a qualifying activity?
- Paid employment (any hours you are scheduled or work)
- Job training or vocational education
- Community college or higher education
- Volunteering with a qualifying nonprofit (up to 80 hours)
- Caregiving for a child under 14 or a person with a disability
Who is exempt?
You do not need to meet the work requirement if you:
- Are under 19 or 65 and older
- Are pregnant or were pregnant in the last 60 days
- Have a physical or mental condition that prevents working
- Are the primary caregiver of a child under 6
- Are in a tribal community with an exemption
- Are already exempt as a recipient of SSI, SSDI, or certain other programs
How do I report my hours?
Each state builds its own reporting portal. Most will require a monthly online report through your state Medicaid agency's website or app. Some states may accept paper forms. You must typically submit your report by the end of each month to keep coverage for the following month.
1. Check if your state has started work requirements — states can begin any time after September 1, 2026.
2. Update your mailing address with your Medicaid agency so you receive all notices.
3. Ask your employer for a letter confirming your hours if needed.
What happens if I miss a month?
If you do not report qualifying activities for a month and are not exempt, your state must give you a notice and a chance to explain before ending your coverage. Most states must provide at least a 30-day notice period. If your coverage ends you can reapply — but there may be a waiting period before you can re-enroll.