Starting [Implementation month & year], some adults applying for or already receiving Medicaid will need to show they are working, going to school, or volunteering for at least 80 hours a month.
Most people that need to meet this new requirement are already doing so through work, school, or because they are exempt (excused).
Who do work requirements apply to?
Work requirements only apply to people on the [name of State Medicaid expansion program] – this is sometimes called the expansion population.
How do I check if I'm on the [name of State Medicaid expansion program]?
You do not have [name of State Medicaid expansion program] if you are:
- Under 16 or over 65
- Receiving SSI/SSDI
- On Medicare
- Pregnant
- Were in foster care at the age of 18 and younger than 26 now
- A parent of a child under 18 and have an income below [X]% of the FPL
This means you will not need to meet work requirements.
Some people are exempt (excused) from work requirements
You are exempt if you are:
- People who are already meeting work requirements for [name or acronym of food program] or [name or acronym of cash program] are exempt from Medicaid work requirements — you don't need to do both.
- People who were pregnant in the last 12 months are exempt from Medicaid work requirements for the full 12-month period.
- Caregivers include relatives, household members of the child, or anyone else who provides at least 80 hours of care per month.
- Relatives and household members of the individual who needs help with daily activities (such as a disabled person or older adult) are exempt from Medicaid work requirements. Any other caregiver who provides at least 80 hours of care per month is also exempt.
- Anyone who aged out of foster care at age 18 and is under age 26 now, is exempt from work requirements.
- Veterans with a 100% disability rating from the VA are exempt from Medicaid work requirements.
- People currently in a treatment program for a drug or alcohol disorder are exempt from Medicaid work requirements.
- People living with a drug or alcohol disorder (sometimes called a substance use disorder or SUD) or people who are in recovery for less than 5 years are exempt from Medicaid work requirements.
- Under the federal law, this counts as being "medically frail."
- People living with a physical, intellectual, or developmental disability that makes it hard to work and do daily activities (such as eating, bathing, walking, or getting out of a bed/chair) are exempt from Medicaid work requirements.
- Under the federal law, this counts as being "medically frail."
- People living with a mental health disorder (such as schizophrenia, major depression, bipolar disorder, panic disorder, etc.) are exempt from Medicaid work requirements.
- Under the federal law, this counts as being "medically frail."
- People with a serious health condition that makes it hard to work (such as cancer, multiple sclerosis, HIV/AIDs, viral hepatitis, and other serious ongoing conditions) are exempt from Medicaid work requirements.
- Under the federal law, this counts as being "medically frail."
- People receiving care in a hospital for more than 24 hours or getting similar care at another location (such as a nursing facility, psychiatric hospital, clinic, the VA, at-home, etc.) are exempt from Medicaid work requirements.
- People traveling an hour or more for medical care for themselves or a dependent with a serious health condition (including doing travel coordination that makes it hard to work) are exempt from Medicaid work requirements.
- American Indians and Alaska Natives who are eligible for Indian Health Service coverage are exempt from Medicaid work requirements.
- People who are currently in jail or prison are exempt from Medicaid work requirements.
- People who were recently released from incarceration are exempt for 3-months after release.
People living in federally declared disaster areas and high unemployment areas are also exempt. [Medicaid agency acronym] will automatically check for these exemptions, residents do not need to report anything.
[Medicaid agency acronym] will use data they already have to check for exemptions, but you may need to let [Medicaid agency acronym] know about your exemptions. Learn more about how to report exemptions.
How do you meet work requirements if you don't have an exemption?
$580 or more in household income
per month*
If your household earned at least $580 this month or last month when applying or in one of the months since your last renewal when renewing, you are already meeting the Medicaid work requirement. Seasonal workers can average their income over 6 months.
This includes all jobs, gig work, self-employment, and sources of unearned income such as unemployment. Make sure you report your job and all income on your application and renewal.
*This is not an income limit for Medicaid eligibility. Find more information on our website about general Medicaid eligibility [General state medicaid website link].
Half-time student or more
If you are a student (college, vocational school, or GED program) full-time, or at least half-time, you are already meeting the Medicaid work requirement. Make sure you report that you are a student on your application and renewal. The number of hours considered as half-time enrollment is determined by each school or program.
Note: Student eligibility rules for Medicaid work requirements are different from [name or acronym of food program] student eligibility [link] and [name or acronym of cash program] work requirements [link].
At least 80 hours of an activity below, or a combination of activities including:
- Employment, job, or internship
- Self-employment or gig work
- Work program
- Volunteering, community service, or unpaid work
- Part-time student activities**
- Caregiving
**For part-time students, 1 credit hour equals 13 work activity hours per month. For programs that do not use credit hours, hours spent in class or participating in educational activities count (such as training, lab work, etc.).
You will need to tell [Medicaid agency acronym] how many hours of each activity you've completed. Your hours must add up to 80 or more for the month you report.
When you apply for Medicaid, you will need to report how you met the requirement for one month before application or for the month you are applying.
When you renew your Medicaid, you will need to report how you met the requirement for one month since your last application or renewal. You can choose which month. Learn more about how to report.
What proof do I need to show my work activities or exemptions?
For exemptions
You do not need to submit documents about your exemption(s) with your application or renewal. [Medicaid agency acronym] will use records we already have to verify information — like food benefit, health, or VA records. If we need something from you, we'll send you a letter.
For meeting work requirements
You do not need to submit additional documents about your work or other activities with your application or renewal, including for volunteering and community service. [Medicaid agency acronym] will use records we already have to verify information — like wage data and education records. If we need something from you, we'll send you a letter.
How do you report exemptions and work activities?
| If you're applying for Medicaid |
Starting [Implementation month & year], the application will include questions about your work activities or exemption status. You'll answer these directly on the application — no separate form or steps are needed. If you're approved, you will need to report your work activities or exemptions on your renewal every 6 months unless you are automatically renewed. Keeping your information up to date will help the state auto-renew your benefits. |
|---|---|
| If you're already on Medicaid |
Starting [Implementation month & year], renewals will include questions about your work activities or exemption status. You'll answer these directly on the renewal — no separate form or steps are needed. If [Medicaid agency acronym] needs information before or after your renewal, we'll send a letter with instructions and a deadline.
If your household is already meeting the Medicaid work requirements through income (making $580 or more in household income in any month between renewals), you'll only need to report your household's income information as usual. If you receive a [name of your state's notice of non-compliance] with your renewal, don't panic! Be sure to fill out the renewal completely with your work hours, income, school, and/or exemptions so they know you're meeting the requirements.
|
| If your situation changes | If anything changes before your next renewal, including your contact information, your work status, household size (including pregnancy), etc., you should report it to [Medicaid agency acronym] online through your [State digital benefits portal] or by visiting a [Medicaid agency acronym] office. |
Frequently Asked Questions
You won't lose coverage without warning. If work requirements apply to you and we don't have the information we need to show you're already meeting the requirements, [Medicaid agency acronym] will notify you via letter and give you the chance to report your activities or exemption(s).
No. You'll only need to report work or an exemption for one of the months between each renewal. Renewals will now happen every six months, instead of once a year. You can choose which month between renewals to report.
Use the information above and information [Medicaid agency acronym] sends you to determine if you are exempt or need to meet the requirements. If you have questions, call the beneficiary helpline at [Beneficiary helpline phone number] or connect with a local community partner.
You don't need to take any action before your next renewal, but if you don't think you will be exempt and are not meeting the work requirements, consider ways you might be able to meet the requirements before your next renewal.
You don't need to take any action before your next renewal unless your situation changes. Make sure to report all exemptions when you renew.
You will not need to report work for both programs. People who are already meeting work requirements for [name or acronym of food program] are exempt from Medicaid work requirements. [Medicaid agency acronym] should check this automatically.
To prepare, update your information and report any changes (such as contact information, work status, household size, etc.) in [State digital benefit portal]. Watch for and complete any paperwork from [Medicaid agency acronym] on time.
[Medicaid agency acronym] will send you a letter or e-notice about any changes or updates. You can also check this website for the most updated information.
One. You'll need to report work or an exemption for the month before you apply or the month you are applying.
They may. If you apply after [Implementation month & year], the application for Medicaid will include questions to check if work requirements apply to you and if you're already meeting them. If they do apply and [Medicaid agency acronym] does not get the information they need from you on the application, they will send you a letter requesting more information.
You may qualify for an exemption. Review the exemptions list above — many common situations are covered. If you're unsure, apply anyway and [Medicaid agency acronym] will help determine what applies to you.
Apply or report anyway. [Medicaid agency acronym] will try to verify your situation using existing records before asking you for anything additional.
No. You'll only need to report work requirement information at the time of application and renewal.
[Medicaid agency acronym] will notify you if you missed a deadline and you'll have a 30-day grace period to submit missing information before your benefits stop.
If you lose coverage you may have to reapply. Be sure to reapply as soon as possible, retroactive coverage is only for one month prior to your application date.
You have the right to appeal. If you receive a determination notice you disagree with, it will include instructions on how to request a hearing.