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A new federal rule asks some adult Medicaid enrollees to report work, school, or community activity hours, usually 80 hours a month. It mainly applies to adults ages 19 to 64 in the Medicaid expansion group. States are still building how this will work, so check your own state Medicaid agency for your exact start date and any exemption.
What happened
A new federal rule now asks some people with Medicaid to prove they work, study, or serve their community. This is separate from the yearly renewal check. The rule is brand new. States are still building how it will work.
What usually applies
A health group summarized this rule for us. It usually asks for 80 hours a month. Those hours can be work, job training, school, or community service. The rule mainly targets adults ages 19 to 64 in the Medicaid expansion group. Some people are usually exempt. This can include people who are pregnant, people a state calls medically frail, and people who care for a young child or a disabled family member. This rule is brand new. Each state is still building its own version. The exact hours, start date, and exemptions can change.
“Demonstrate 80 hours per month of one or more of the following activities: Work, participation in a work program, enrollment in an educational program, community service, or a combination of these activities.”
“The provisions take effect July 31, 2026, with state implementation required by January 1, 2027.”
“Adults aged 19-64 enrolled through the Affordable Care Act Medicaid expansion or certain 1115 demonstration waivers providing minimum essential coverage must comply”
What to do
- 1
Watch for a letter from your state Medicaid office
States decide the exact reporting process and send the notice explaining it. Do not assume one national start date applies to you until your state confirms it.
- 2
Check whether an exemption might fit you
Some people do not have to follow this rule. This can include people who are pregnant, people a state calls medically frail, and people who care for a young child or a disabled family member. Your state agency confirms what applies to you.
- 3
Keep proof of your hours or your exemption
Pay stubs, school records, or a note about caregiving can help later. This proof can support your hours or your exemption once your state's process starts.
- 4
Ask your state Medicaid agency directly
This rule is still new. Your state agency has the most current answer. They know your own reporting date and method.
You may get a notice that your Medicaid could end because of this rule. If so, you can usually ask for a fair hearing first. Legal aid offices and your local 211 line can help you understand the notice.
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Sources
- Center for Health Care Strategies (CHCS)Retrieved 2026-07-08
Last reviewed 2026-07-08