New Medicaid work rule starts in 2027—80-hour monthly requirement ahead

A new federal rule will require certain Medicaid beneficiaries in expansion states to work, volunteer, or attend school for at least 80 hours a month from January 1, 2027. The policy, released by the Centers for Medicare and Medicaid Services in June 2022, sets standards for verification and defines exemptions more clearly The rule primarily affects adults aged 19 to 64 who are not exempt and live in states that expanded Medicaid. Exemptions cover groups such as pregnant women, caregivers, disabled veterans, foster youth, and individuals with substance use disorders.

States must verify compliance using existing data and allow a 30-day grace period for violations. Beneficiaries will also need to have their eligibility redetermined at least twice a year to confirm they still meet the requirements.

Some states, including Nebraska, Arkansas, and Montana, are rolling out the rule before the official start date. Wisconsin, however, plans to launch on January 1, 2027, estimating that around 63,000 residents will be impacted. Experts and advocates argue the rule provides states with less flexibility than expected. They also note it narrows the definition of 'medical frailty' exemptions. The changes will reshape how some Medicaid recipients maintain their coverage.