Medicaid work requirements: the 80-hour rule, who is exempt and when it starts

Who must meet the rule

The rule is in section 1902(xx) of the Social Security Act and 42 CFR 435.550 to 435.563. It applies in the 50 states and D.C., not in the territories. It covers adults 19 to 64 in the expansion group, or in a waiver that covers the same adults, who are not pregnant or on Medicare.

What counts each month

You meet the rule for a month with any one of these:

• Work at least 80 hours. Paid, in-kind and unpaid work all count.
• Do at least 80 hours of community service with a public or nonprofit group that tracks your hours.
• Take part in a work program for at least 80 hours, such as state job training.
• Go to school at least half-time. This includes college, career and technical school, high school and high school equivalency classes.
• Do any mix of these for at least 80 hours.
• Have monthly income of at least the federal minimum wage times 80 hours. At $7.25 an hour, CMS puts that at $580 in 2026.
• Be a seasonal worker whose income over the last 6 months averaged that amount.

Who does not have to meet it

The rule does not apply to:

• Parents, guardians, caretaker relatives and family caregivers of a child 13 or younger or of a person with a disability.
• People who are medically frail, such as people who are blind or disabled or who have a substance use disorder, a disabling mental disorder or a serious or complex condition. States keep a list of conditions, and you can ask to be considered if yours is not on it.
• People who are pregnant or in the postpartum period.
• American Indians, Alaska Natives and others eligible for the Indian Health Service.
• Veterans with a VA disability rated total.
• Former foster care youth in their Medicaid group.
• People who meet TANF work rules, members of a SNAP household who are subject to SNAP work rules, and people in drug or alcohol treatment.
• People in jail or prison.

The state must also count a month as met if you were under 19, on Medicare, in certain other required Medicaid groups, or left jail or prison in the 3 months before. A state may also excuse a month for a hospital stay, a disaster area, a county with high unemployment or long travel for serious care.

How the state checks

At application, the state checks 1 to 3 months in a row before the month you apply. If you are enrolled, it checks 1 or more months between renewals, at renewal or more often. The first check for people already enrolled comes at the first renewal started on or after the state's start date.

The state must first use data it has, such as payroll records, other agencies and Medicaid claims. It can ask you only if that data is not enough. If it still cannot confirm, it must mail a notice. You get 30 calendar days from receipt to show that you met the rule or are excluded. The notice counts as received 5 days after its date. If you are enrolled, coverage continues during that time.

If you do not, the state must first check if you can get Medicaid another way. Only then may it deny or end coverage, no later than the end of the month after the 30 days. You get written notice and the right to a fair hearing. You can reapply at any time.

Key dates

States must warn people by mail and one more way before the start date. CMS can give a state a good faith exemption of up to 6 months, with extensions, but never past Dec. 31, 2028.

Frequently asked questions

When does the Medicaid work rule start?

States must apply it to coverage on or after Jan. 1, 2027. A state can start earlier, and CMS can give a state more time, but never past Dec. 31, 2028.

Does the rule apply in states that did not expand Medicaid?

Only where the state covers the expansion group, or similar adults through a waiver.

What happens if I lose Medicaid under this rule?

Federal law treats you as able to get Medicaid for those months, so you cannot get premium tax credits for a Marketplace plan for them.

Do I have to send pay stubs every month?

No. The state checks at application and at renewal, or more often if it chooses, and it must try its own data first.