Medicaid Work Requirements: What Changes in 2027

On this page

• What the rule requires
• Who is exempt
• When it starts in your state
• How states will check
• What happens if you don’t meet it
• Other Medicaid changes coming
• What to do now
• Frequently asked questions

What the rule requires

The requirement is officially called community engagement. It applies to adults 19 through 64 who are covered as part of a state’s Medicaid expansion, or a similar waiver program, and who aren’t pregnant and don’t have Medicare. CMS says 43 states and the District of Columbia will have to put it in place.

Each month, you meet the rule if you do any of these:

• Work at least 80 hours
• Do at least 80 hours of community service
• Take part in a work program for at least 80 hours
• Go to school at least half-time
• Have monthly income of at least 80 times the federal minimum wage, which is $580 today

You can combine work, volunteering and a work program to reach 80 hours. The rule doesn’t apply to children, adults 65 and older, or most people who get Medicaid because of a disability. For how Medicaid works in general, see health insurance for low-income families.

Who is exempt

You don’t have to meet the requirement if you’re:

• A parent, guardian or caretaker of a child 13 or younger, or of a person with a disability
• Pregnant or postpartum
• Medically frail, which includes people who are blind or disabled, have a substance use disorder, a disabling mental disorder, or a serious or complex medical condition that makes it hard to meet the rule
• A veteran with a total disability rating
• American Indian or Alaska Native
• A former foster youth under 26
• In a drug or alcohol treatment program
• Meeting the work rules for SNAP (food stamps) or TANF
• In jail or prison, or released within the last three months

States can also excuse people for short stretches, such as a hospital or nursing home stay, living in a county with high unemployment or a declared disaster, or traveling for treatment of a serious illness. Not every state will offer these.

The medically frail exemption is being fought in court. CMS’s rule says a condition has to significantly impair your ability to meet the requirement. Twenty-five states and D.C. sued, arguing that’s narrower than the law. A judge declined to block the rule in July 2026, and the case is still going.

When it starts in your state

The deadline for most states is January 1, 2027, but states could start sooner, and some have.

State	Status
Georgia	Has required work or other activities in its Pathways program since July 2023
Nebraska	Started May 1, 2026
Montana	Started July 1, 2026
Arkansas	Soft launch July 1, 2026; no one loses coverage before January 1, 2027
Iowa	Starts December 1, 2026
Most other expansion states	January 1, 2027

States that show they’re making a good-faith effort can ask for more time, but every state has to be in compliance by the end of 2028. Your state Medicaid agency’s website will list its start date.

How states will check

States have to look at records they already have before asking you for anything. That includes SNAP and TANF files, state wage records, unemployment data and payroll databases. If those show you work enough hours or earn enough, you may not have to do anything.

If the state can’t confirm it, you’ll be asked for proof, like pay stubs, a letter from a volunteer group or school enrollment records. Until 2028, states can accept your signed statement. After that, they must ask for documents when they’re reasonably available.

When you apply, the state will look back at one to three months before your application, depending on the state. After you’re enrolled, it will check again at each renewal, and some states will check more often.

What happens if you don’t meet it

If the state finds you didn’t meet the rule, it has to send you a notice. You then have 30 days to show you did meet it or that you’re exempt. If you’re already enrolled, your coverage continues during those 30 days.

If you can’t show it, your Medicaid will be denied or ended. You can reapply later. But you also won’t be able to get a premium tax credit for a Marketplace plan, so buying coverage on your own gets much more expensive.

The Congressional Budget Office estimated this rule will leave 5.3 million more people uninsured in 2034, including many who meet the rule but lose coverage over paperwork.

Other Medicaid changes coming

• Renewals every six months. Starting with renewals on or after January 1, 2027, expansion adults will have to renew twice a year instead of once.
• Less back coverage. For applications starting January 1, 2027, Medicaid will pay for care in the month before you apply for expansion adults, and two months for others. It used to be three.
• Copays. Starting October 1, 2028, states must charge expansion adults above the poverty level copays of up to $35 per service. Primary care, mental health and addiction care, and community health center visits are exempt, and total costs are capped at 5% of household income.

What to do now

1. Update your address, phone and email with your state Medicaid agency. Notices about the new rule are going out now, and missing one is the easiest way to lose coverage.
2. Open every letter from your Medicaid agency and answer by the deadline.
3. Keep records of pay stubs, volunteer hours and school enrollment.
4. Tell the state if you’re exempt. If you’re caring for a young child, pregnant, or have a health condition that limits your ability to work, say so and ask what proof they need.
5. Have a backup plan. If you might lose Medicaid, look at job-based coverage and community health centers, which charge on a sliding scale. See health insurance for the unemployed and how to get mental health help without insurance.

Losing Medicaid for other reasons, like a higher income, still opens a special enrollment period for a Marketplace plan. See qualifying life events.

Not sure you’ll qualify for Medicaid in 2027? Compare other coverage options in your area.

Frequently asked questions

When do Medicaid work requirements start?

Most states must start by January 1, 2027. Nebraska and Montana have already started, Iowa starts December 1, 2026, and Georgia has had its own version since 2023.

How many hours do you need to work to keep Medicaid?

80 hours a month of work, community service, a work program or a mix of them. Half-time school or monthly income of at least $580 also counts.

Do parents have to meet the work requirement?

Not if they’re caring for a child 13 or younger. Parents of older children aren’t exempt unless another exemption applies.

Does the work requirement apply to people on disability?

People who get Medicaid because of a disability generally aren’t in the expansion group, so the rule doesn’t apply. Expansion adults who are blind or disabled count as medically frail and are exempt.

This article is general information, not legal advice. Each state runs its own Medicaid program, so check with your state Medicaid agency for its rules and dates. Last reviewed September 2026.