Medicaid Work Requirements Begin Rolling Out State by State
New Medicaid community-engagement rules, created by the 2025 reconciliation law, require non-pregnant adults ages 19-64 in the ACA expansion population to complete at least 80 hours per month of work, school, volunteering, or job training to keep coverage. Nebraska became the first state to begin enforcement, starting work requirements on May 1, 2026, according to the Nebraska Department of Health and Human Services.
Montana and Iowa are following with earlier-than-mandated start dates of July 1 and December 1, 2026, respectively, while most of the 43 states covered by the rule are targeting the federal deadline of January 1, 2027, according to KFF's survey of state Medicaid officials.
The rule has drawn legal pushback. A tracker from BenefitsUSA reports a coalition of 25 states and Washington, D.C. sued the federal government in late June 2026 over how narrowly the June 2026 federal guidance defines who counts as "medically frail" and therefore exempt.
Exemptions remain broad on paper — including pregnancy, disability, caregiving for a young child, and living in a high-unemployment county — but verification requirements are tightening over time. If you're on Medicaid or think you might qualify, run your situation through the Benefit Trim Score to see which other programs you may also be eligible for.