Medicaid Work Requirements Begin in 2027: Who Must Follow the Rules and Who May Be Exempt

Medicaid Work Requirements Begin in 2027: Medicaid is going through some big changes. The program still helps people with low income get medical care. It covers children, pregnant women, older people, adults with disabilities, and other people who meet the rules.

The program is paid for by both the federal government and state governments. Federal rules set the basic requirements, but each state runs its own Medicaid program. This means income limits, covered services, and application rules can be different depending on where a person lives.

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New Medicaid Work Requirements will begin in 2027

The new federal Medicaid work rule will generally begin on January 1, 2027, although states may start earlier. It mainly applies to certain adults ages 19 to 64 in the Medicaid expansion group or a similar waiver program. The person must be non-pregnant and not enrolled in Medicare.

People covered by the rule will usually need to complete at least 80 hours of approved activity each month. This may include working, job training, community service or attending school at least half-time. Earning at least $580 per month in 2026 may also meet the rule.
New applicants may need to prove they met the requirement for one to three months before applying. Current members may need to show proof during Medicaid renewals.

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Many people will be exempt. This may include pregnant and postpartum people, former foster youth, certain American Indians and Alaska Natives, fully disabled veterans and caregivers of a child under 14 or a person with a disability. People who are blind, disabled, medically frail, seriously ill or receiving certain substance-use treatment may also qualify for an exemption.

States should first use information they already have. They may ask for medical records, work records or other proof. If the state cannot confirm that a person meets the rule or qualifies for an exemption, it must give them 30 days to respond. Coverage continues during that period for current members. Missing the deadline may lead to denied or ended coverage, but the person can apply again later.

Adults will have Medicaid reviewed every six months

Medicaid members must complete regular eligibility checks called “redeterminations.” During these reviews, the state may check income, household size and residency.
Starting January 1, 2027, most adults in the Medicaid expansion group will be reviewed every six months instead of once a year. Some American Indians, Alaska Natives and people in other Medicaid groups may still have yearly reviews.

Members should keep their address, phone number, and email updated. They should also return forms on time because missing a notice could cause coverage to stop. Children under 19 usually receive 12 months of continuous Medicaid or CHIP coverage, even if some family details change.

Coverage and future Medicaid costs may vary by state

The new work rule is a federal change, but many other Medicaid decisions are still made by individual states. One state may cover a service that another state does not. States also use different managed care companies, provider networks, and payment systems. Medicaid managed care plans deliver benefits through agreements between state Medicaid agencies and private managed care organizations.

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A Medicaid plan may change its doctor network, hospital network, drug coverage rules, or prior authorization process. Members should read plan notices to find out whether their doctor or medicine is still covered. A person should contact the plan before changing treatment or stopping a prescription.

Future Medicaid Costs may vary by State

There is also another federal cost change planned for October 1, 2028. States will have to charge certain Medicaid expansion adults with family income above 100% of the federal poverty level for some services. The charge may be as high as $35 for one service. States will not be allowed to charge these adults a Medicaid premium or enrollment fee.

Primary care and behavioral health services will be protected from this new charge. Care provided through federally qualified health centers, rural health clinics, and certified community behavioral health clinics will also be exempt. A family’s total Medicaid costs cannot be more than 5% of its family income.