Under H.R.1 — also called the One Big Beautiful Bill Act — many Medicaid members ages 19 to 64 must complete around 80 hours of qualifying activity each month and report those hours to their state to keep their coverage. Federal enforcement starts January 1, 2027. States are mailing notices now, during the June 30 to August 31, 2026 window. This guide walks you through who must report, what counts, and exactly how to do it.
Who has to report?
Most Medicaid expansion adults ages 19 to 64 who do not fall into an exempt category are required to report. You are likely not required to report if you are a parent or caretaker of a child under 14, pregnant or postpartum, disabled or medically frail, in substance-use-disorder treatment, an American Indian or Alaska Native member, a qualifying student, or facing a short-term hardship. If any of those situations apply to you, use the free Am I Exempt? tool first — you may not need to report at all. If you are not sure whether you are exempt, contact your state Medicaid office or health plan to get your status confirmed in writing before the January 2027 deadline.
What counts as qualifying activity?
You do not have to hold a traditional full-time job to meet the 80-hour requirement. Qualifying activities in most states include: paid employment (full-time, part-time, or seasonal), self-employment, unpaid community service or volunteering, participation in a state-approved work program or job-placement program, enrollment in school at least half-time, and enrollment in a job-skills training or vocational program at least half-time. You can combine categories — for example, 40 hours of part-time work plus 40 hours of approved volunteer service counts in most states. Caring for a seriously ill family member may also count as a qualifying activity in some states. Check your state's specific list, because states have some flexibility in which activities they accept. Rules vary by state, and only your state Medicaid agency can confirm exactly what qualifies.
What documents should you keep?
Before you report, gather proof of your hours. Useful documents include: pay stubs or employer earnings statements, a signed letter from a supervisor or volunteer coordinator on organization letterhead, a school enrollment verification or class schedule, a training-program attendance record, a self-employment income log with dates and hours, or a record from a state-run work program. Keep these documents even after you submit your report — states can ask you to verify your hours again later. A simple paper folder, a phone photo of each document, or a free cloud folder all work fine.
How to report online
Most states will offer a member portal or website for reporting. Log in to your state Medicaid member account — sometimes this is the same portal you use for renewal. Select the reporting period (the month you are reporting for), enter your activity type, the number of hours, and the dates. Upload or photograph your supporting document if the system asks. Submit and then save your confirmation number or take a screenshot. That confirmation is your proof that you reported on time. If you do not have internet access, contact your local library, community health center, or health plan for help getting online.
How to report by phone
Call the Medicaid member services number on the back of your insurance card or the number listed on your notice letter. Tell the representative you are calling to report your community-engagement hours for the month. They will ask for your name, member ID, and the details of your activity — type, hours, and dates. Ask for a reference or confirmation number at the end of the call and write it down with the date and the representative's name. Phone reporting is a good option if the online portal is not working or if you need help navigating the form.
How to report by mail
Some states accept a paper reporting form mailed to the Medicaid agency. Use the form included with your notice letter, or download it from your state's Medicaid website. Fill it out completely, attach copies (not originals) of your supporting documents, and send it with enough lead time to arrive before the monthly deadline — mail can take several days. Keep a copy of everything you send, and consider using certified mail so you have a delivery record.
What is the monthly deadline?
Most states require you to report by a fixed day of the month following the reporting period — for example, report your May hours by June 15. Your notice letter will state the exact deadline for your state. Mark it on your calendar every month. Reporting late is treated the same as not reporting at all in most systems. If you are not sure of your deadline, call your health plan or state Medicaid office and ask them to confirm it in writing.
What if you are exempt instead of reporting?
If you qualify for an exemption, you do not need to meet the 80-hour requirement — but you do need to make sure your state has your exemption documented. Contact your state Medicaid office or health plan to submit your exemption claim with the supporting documentation (for example, a birth certificate for a caretaker exemption, a doctor's letter for a medical exemption, or enrollment records for a student exemption). Once your exemption is on file, you should not be flagged for non-reporting. Check in periodically to confirm the exemption is still active, because some exemptions expire and need to be renewed.
Where to get help
If you are confused about any step, help is available at no cost. Contact your Medicaid health plan — the number is on your insurance card — and ask for a member services representative who can walk you through the reporting process in your language. Your state Medicaid agency also has a member help line. Community health centers and Federally Qualified Health Centers (FQHCs) often help members with Medicaid paperwork. Many states also provide in-person assistance at local social-services offices. Do not try to figure this out alone if you are uncertain — one missed report can end your coverage for the next month. Rules vary by state, and only your state Medicaid agency can confirm the exact steps, deadlines, and exemptions that apply to you.