Medicaid Work Requirements
State Digital Interactive Guide (DIG) for Medicaid Work Requirements
This tool was designed for community partners to help residents navigate new work requirements for Medicaid.
- This is not a determination or an application.
- This is not designed to assess Medicaid eligibility in general. For more information about general eligibility, visit SDHHS' Medicaid website.
- Information provided here cannot be used as proof when applying for or renewing Medicaid benefits.
- For more details about Medicaid work requirements, visit SDHHS' State Expansion Plan (SEP) website.
This tool does not save or send any information to SDHHS. Download, print, or copy the summary when you're done to save information.
Important legal information
This tool is an informational resource about what Medicaid coverage Medicaid applicants or renewing members may be qualified for. This is not an official application or renewal. It is not intended to provide official eligibility decisions or determinations and cannot be used as proof that you are complying with, or exempted from, work requirements, if applicable. To officially apply for or renew Medicaid coverage, you must contact the State Department of Health & Human Services or log into State portal for more information.
The information provided in this tool is for general informational and educational purposes only. All information in the tool is provided on an "as-is" and "as-available" basis. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability of the tool or the information, products, services, or related graphics contained therein for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
State Digital Interactive Guide (DIG) for Medicaid Work Requirements
This tool was designed for community partners to help residents navigate new work requirements for Medicaid.
- This is not a determination or an application.
- This is not designed to assess Medicaid eligibility in general. For more information about general eligibility, visit SDHHS' Medicaid website.
- Information provided here cannot be used as proof when applying for or renewing Medicaid benefits.
- This tool does not save or store any information. Download, print, or copy the summary when you're done if you need a record.
- For more details about Medicaid work requirements, visit SDHHS' State Expansion Plan (SEP) website.
Household members
Only adults ages 19–64 are subject to work requirements. Add each adult separately — the tool tracks their status individually.
State Expansion Plan (SEP)
State Expansion Plan (SEP): Do any of these situations apply to this person?
(Check all that apply)
Work requirements only apply to people enrolled in SEP, sometimes called the Medicaid expansion population. Work requirements do not apply to someone if any of the following are true.
Under 19 or 65 and older
Children and older adults are not on SEP and are not subject to work requirements.
Receives SSI or SSDI due to a disability
Adults on SSI/SSDI are not on SEP and are not subject to work requirements.
Currently pregnant
Pregnant people are not on SEP and are not subject to work requirements.
Enrolled in or entitled to Medicare Part A or Part B
People with Medicare coverage are not subject to work requirements.
Former foster youth under 26
Anyone who aged out of foster care at age 18, and is under 26 now, is not subject to work requirements.
Parent of a child under 18
All parents of children under 18 are either not on SEP, exempt, or already meeting the requirements. They will not need to take any additional steps to complete work requirements.
🏠 Household question
Is the household income below 54% of the Federal Poverty Level (FPL)?
For a family of 2: $11,469 per year · For a family of 4: $17,490 per year
This is about the whole household's income, not just this person — you'll only need to answer it once, no matter how many household members you add.
Yes
No
Are any of their children under 14 years old?
Yes
No
None of these apply
This person is likely on SEP.
Disability + health conditions
Health-related exemptions: Do any of these situations apply to this person?
(Check all that apply)
People should report all applicable exemptions on their applications and renewals. At application, people should report exemptions that apply for the current month and last month — the month may determine the coverage start date. At renewal, people only need to have had an exemption for one month since their last renewal to be exempt.
Postpartum or gave birth in the last 12 months
Postpartum people are exempt for the full 12 months after a pregnancy ends.
Living with a physical, intellectual, or developmental disability that makes it hard to work
The disability must make it hard to work and do daily activities such as eating, bathing, walking, or getting out of a bed/chair.
Living with a mental health disorder that makes it hard to work
The mental health condition must make it hard to work. This exemption includes conditions such as schizophrenia, major depression, bipolar disorder, panic disorder, etc.
Living with a drug or alcohol disorder that makes it hard to work
The disorder must make it hard to work. This exemption includes people who have been in recovery for less than 5 years. This is considered a separate exemption from being in a treatment program for a drug or alcohol disorder.
In a treatment program for a drug or alcohol disorder
This is considered a separate exemption from living with a drug or alcohol disorder.
Living with a serious health condition that makes it hard to work
The health condition must make it hard to work. Exemptions include conditions that are life threatening, cause significant pain, require major effort or regular treatment, or that need coordination of multiple specialties. For example: cancer, multiple sclerosis, HIV/AIDs, viral hepatitis, etc.
Traveling an hour or more to get medical care
Traveling an hour or more to get medical care for themselves or a dependent with a serious health condition. This exemption also includes having to do travel coordination that makes it hard to work.
Receiving medical care
Receiving care in a hospital for more than 24 hours, or getting a similar level of care at another location such as a nursing facility, psychiatric hospital, clinic, the VA, at-home care, etc.
None of these apply
Other exemptions + situations
General exemptions: Do any of these situations apply to this person?
(Check all that apply)
People should report all applicable exemptions on their applications and renewals. At application, people should report exemptions that apply for the current month and last month — the month may determine the coverage start date. At renewal, people only need to have had an exemption for one month since their last renewal to be exempt.
A non-parent caregiver of a child under 14
Caregivers that are relatives or household members of the child do not need to meet a minimum number of hours per month. Anyone else who provides at least 80 hours of care per month also counts as a caregiver. If someone provides less than 80 hours per month, they can count those hours as work activities.
A caregiver of someone who needs help with daily activities
Includes caregiving for a disabled person or older adult. Caregivers that are relatives or household members of the person do not need to meet a minimum number of hours per month. Anyone else who provides at least 80 hours of care per month also counts as a caregiver. If someone provides less than 80 hours per month, they can count those hours as work activities.
A disabled veteran
Must have a 100% disability rating from the VA.
American Indian or Alaska Native (AI/AN)
A member of an Indian tribe, including American Indian, Alaska Native, Urban Indian, California Indian, or someone eligible for Indian Health Service coverage.
Already required to meet SNAP or TANF work requirements
Select to see sub-options below.
In jail or prison now or in the past 3 months
Exempt while in prison and for three months after they are released.
None of these apply
Already meeting work requirements
Already meeting work requirements: this person
There are three ways to meet the Medicaid work requirement: meeting or exceeding a minimum household income threshold, being a student half-time or more, or reporting 80 hours of work activities in a month. Any one of these three is enough.
🏠 Household question
Household income: Does this household make at least $580 in monthly income?
Households making $580 or more count as meeting the work requirement, using MAGI household income calculations. Income includes all jobs, gig work, seasonal work, and unearned income such as unemployment. States will try to verify this income using wage data before asking for additional verification. Income from seasonal work can be averaged across 6 months.
This is about the whole household's income, not just this person — you'll only need to answer it once, no matter how many household members you add.
This answer is autofilled because it's already determined by the household income answer in the "Parent of a child under 18" question above. To change it, update that answer instead — this one will update automatically.
Yes — earned at least $580 this month, last month, or in at least one month since their last renewal
This household is meeting the work requirement through income and does not need to report hours.
No — earns below $580 per month or monthly income is unknown
This person will need to meet work requirements through work activities or school.
Student status: Is this person enrolled in a college, vocational, or GED equivalent program?
Students enrolled at least half-time meet the work requirement. The number of hours considered as half-time enrollment is determined by each school or program. Part-time student hours can count towards the 80-hour requirement.
Yes — enrolled at least half-time
Being a student at least half-time counts as meeting the work requirement. States will try to verify this using enrollment records before asking for more information.
Not currently enrolled or enrolled less than half-time
This person will need to meet work requirements through work activities or the income threshold. Part-time student hours can count toward the 80-hour requirement for work activities (see qualifying activities below).
Qualifying activities: Is this person already doing at least 80 hours of qualifying activities per month?
Activities can be combined to reach 80 hours. Select each one that applies.
A job, internship, or gig work
Working people should report all work on their application or renewal. The state will try to verify automatically, no additional proof is needed unless requested by the state.
Self-employment
Self-employed people should report all self-employment on their application or renewal. The state will try to verify automatically, but additional documentation such as bank statements, invoices, or a self-attestation form may be requested in a verification letter.
Unpaid work
Unpaid work includes work done in exchange for goods or services (sometimes called work "in-kind"). People doing unpaid work should report hours on their application or renewal.
Work program
Work programs include state-run programs like SNAP employment and training. People in a work program should report the program on their application or renewal. Participation records from the program usually count as verification, if requested in a verification letter.
Volunteering or community service
Community service includes volunteering with a non-profit, school, emergency relief organization, or other organization. Volunteers should report their hours on their application or renewal.
Part-time school or vocational program
For part-time students, 1 credit hour equals 13 work activity hours per month. For programs that do not use credit hours, any hours spent in class and participating in educational activities count (such as training, lab work, etc.). Students should report their student status on their application or renewal. Enrollment records can typically serve as verification, if requested in a verification letter.
Caregiving
Caregivers of children under 14 or caregivers of people who need help with daily activities can count their caregiving hours. Caregivers should report their hours on their application or renewal.
Not currently completing any work activities
Total hours0 out of 80
On verification: States check wage data and other existing data records first. People may only need to provide proof if the state can't verify information automatically. It may help to have records available when possible such as pay stubs, class schedules, or letters from organizations they volunteer with.
Your summary
Selections will appear here as you work through the guide.