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Medicaid work requirements in 2027

Adults 19-64 who get Medicaid through the ACA expansion group (or a similar 1115 waiver, e.g. Georgia, Wisconsin) must show 80 hours a month of work or other activities, unless excluded. States must start by January 1, 2027; they may start earlier (Nebraska began May 1, 2026). Expansion adults also get eligibility renewed every 6 months starting with renewals on or after Jan 1, 2027.

What counts each month

For each month checked, do ONE of: work 80 hours (paid, in-kind, or unpaid); 80 hours of community service; 80 hours in a work program; be enrolled in school at least half-time; any mix adding up to 80 hours; OR have monthly income of at least $580 (80 x $7.25 federal minimum wage). Seasonal workers can use a 6-month average of $580/month.

Who is exempt

Are you pregnant, or did you have a baby recently (postpartum coverage)? Specified excluded: pregnant or entitled to postpartum Medicaid.
Were you in foster care when you turned 18, and are you under 26? Specified excluded: meets the former foster care children group definition (sec. 1902(a)(10)(A)(i)(IX)), from any state, regardless of whether you turned 18 before 2023.
Are you American Indian or Alaska Native (or eligible for Indian Health Service)? Specified excluded: 'Indian' as defined at 42 CFR 447.51 (covers Indian, Urban Indian, California Indian, and anyone IHS-eligible as an Indian).
Do you care for a child 13 or younger, or a person with a disability? Specified excluded: parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 or under, or of a disabled individual (ADA definition; they don't need to be on disability benefits). Family caregiver counts if you live with them and help regularly; or you are a relative helping regularly; or, if neither, you give 80+ hours/month of care. More than one adult in the home can qualify.
Are you a veteran with a VA disability rating of 100% (total)? Specified excluded: veteran with a temporary or permanent VA disability rated 100% (total) under 38 U.S.C. 1155. Lower ratings do not qualify on this basis.
Do you have a health condition that makes it very hard to work or do activities? Specified excluded: medically frail / special medical needs, meaning a condition that SIGNIFICANTLY IMPAIRS your ability to meet the requirement AND you are: blind or disabled (SSA definition); have a substance use disorder (not if in stable recovery 5+ years); have a disabling mental disorder; have a physical, intellectual or developmental disability that limits 1+ activities of daily living; or have a serious or complex medical condition. States must publish a condition list and let people outside the list ask for review.
Are you following TANF (cash aid) work rules? Specified excluded: complying with state TANF work requirements (sec. 407). Must actually be complying.
Do you get SNAP (food stamps) and have to follow SNAP work rules? Specified excluded: member of a household getting SNAP who is NOT exempt from a SNAP work requirement (general or time-limit). CMS says the state does NOT have to confirm you are actually meeting SNAP rules, only that you are subject to them. 91 FR 33377.
Are you in a drug or alcohol treatment program? Specified excluded: participating in a drug addiction or alcohol treatment and rehabilitation program (FNA sec. 3(h)). States may set a minimum time commitment.
Are you in jail or prison now? Specified excluded: inmate of a public institution.
Were you released from jail or prison in the last 3 months? Mandatory exception: deemed compliant for a month if you were an inmate at any point in the 3 months ending on the 1st of that month.
During the month checked, were you under 19, on Medicare, or in a different Medicaid group? Mandatory exception: deemed compliant for any month where for part or all of it you were under 19, entitled to/enrolled in Medicare Part A or B, or in a mandatory Medicaid group (1902(a)(10)(A)(i)(I)-(VII)).
Are you 65 or older? Not an 'applicable individual' (rule covers 19 through 64).

Short-term hardship exceptions (state option)

Were you in the hospital, a nursing home, or a psychiatric hospital this month?
Is your county under a federal disaster or emergency declaration?
Is unemployment in your county very high?
Did you or your dependent have to travel far for serious medical care?

How your state will check

The state must first check its own data (payroll, SNAP/TANF records, claims) before asking you for anything. If it can't confirm, it sends a notice and you get 30 days to show proof; coverage continues during that time. Until Dec 31, 2027 states MAY accept other information (like your statement) instead of documents. Starting Jan 1, 2028 they MUST ask for documents when they're reasonably available.

Answer every notice. If your state asks for proof, you get at least 30 days to respond, and your coverage continues while you do.

How to prove your hours

Pay stubs showing hours and dates are the standard proof. SNAP lists wage stubs as the main kind of documentary evidence; CMS lists paystubs as 'reasonably available' proof of hours or income.
No pay stubs? Ask your employer for a signed letter with your hours per week/month, pay, dates, and a phone number. SNAP can also call an employer as a 'collateral contact' you name.
Volunteer / community service: get a letter or log from the organization with its name and address, what you did, the dates and hours, and a contact person (name + phone/email) who can confirm. For Medicaid the group must be public or nonprofit and non-partisan.
Work program / SNAP E&T: keep attendance or sign-in records from the provider. Programs the SNAP agency runs may already report your hours; others must be verified.
School: class schedule, enrollment letter, or transcript showing half-time or more (or your credit hours if less).
Gig and self-employed work: keep a daily log of actual hours (date, start, end, task) PLUS the app's earnings statements (e.g., weekly payout summaries) and any 1099s. Some states won't turn earnings into hours for SNAP, so the hour log matters. For Medicaid, $580+/month household income may be enough on its own.
Exemption proof: VA rating letter (100% for Medicaid), SNAP or TANF approval notices, doctor's statement for health limits, tribal enrollment or IHS eligibility papers.
Caregiving with no paperwork: write down who you care for, how you're related, where they live, and hours per week. States must accept other information when no documents exist.
Answer every notice within 30 days. In Nebraska, 92% of people who lost Medicaid at renewal simply didn't respond to the request for information.
You never have to bring proof in person for SNAP; you can mail, fax, upload, or send it through an authorized representative. Medicaid must take proof by all application channels (online, phone, mail, in person).
Keep copies of everything you send and the date sent. States must keep case files that support their decision, and you have fair-hearing rights.

Check if you’re exempt · Your state’s guide

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Sources

This page explains federal rules as of October 10, 2026. It is not legal advice and my80hours is not a government site. Your state sets many details, so always follow the notices your state sends you, and ask your caseworker or a legal aid office if you’re unsure.