Under the H.R.1 community-engagement requirements, many Medicaid members ages 19 to 64 must complete around 80 hours of qualifying activity each month — work, school, job training, or community service — and report those hours to their state to keep their coverage. Federal enforcement begins January 1, 2027. If you do not report on time, you can lose your Medicaid coverage even if you did the hours. That is the part most people do not expect.
What happens if you miss a reporting deadline?
If your state does not receive your report by the deadline, the system treats you as non-compliant. Your coverage can be suspended or terminated the following month. This is called a procedural disenrollment — you lose coverage not because you failed to qualify, but because the paperwork was missing. To get coverage back you generally have to reapply, which creates a gap and can delay care.
Not reporting is different from not qualifying
There are two separate problems people confuse. The first is not meeting the 80-hour requirement — not working, not in school, no qualifying activity that month. The second is not reporting hours you did complete. The second one is more common and more avoidable. In Arkansas’s earlier work-requirement program, roughly 18,000 people lost Medicaid coverage, and analyses found that about one in four subject enrollees lost coverage largely because they did not understand how or when to report — not because they were not working. You can be doing everything right and still lose coverage if the paperwork does not reach the state on time.
What if you are exempt — do you still have to do anything?
Being exempt does not protect you automatically. You have to claim your exemption. If your state’s system has not recorded your exemption — whether you are a parent of a child under 14, pregnant or postpartum, disabled, in substance-use-disorder treatment, an American Indian or Alaska Native member, or another qualifying category — you may still be flagged for non-reporting. The exemption only works once your state has it on file. Check with your state Medicaid office or health plan to confirm your exemption status is documented. If you are unsure whether you qualify, use the free Am I Exempt? tool to check common exemption categories.
Many people are exempt and do not know it
Federal law requires states to exempt a broad set of categories: parents and caretakers of children under 14, pregnant and postpartum individuals, people who are disabled or medically frail, members in substance-use-disorder treatment, American Indian and Alaska Native members, certain students, and others in short-term hardship situations. If any of those describe you, you likely do not need to meet the 80-hour rule — but you do need to make sure the state knows. Unclaimed exemptions are one of the most preventable causes of coverage loss.
How do you avoid losing coverage for a paperwork reason?
There are three things you can do right now. First, find out if your state has started its community-engagement program — states began notifying members between June 30 and August 31, 2026, and enforcement starts January 1, 2027. Second, if you are working or engaged in qualifying activities, start tracking your hours and documents now so reporting is easy once your state opens its portal. Third, if you think you may be exempt, contact your health plan or state Medicaid office and ask them to document it. Do not wait for a termination notice to figure this out.
What should you do if you already lost coverage?
If your coverage was terminated because you missed a deadline, contact your state Medicaid office right away. Most states have an appeals and fair-hearing process. If you were working or you are exempt, you may be able to get your coverage reinstated retroactively. Act quickly — appeal deadlines are usually 90 days or less, and each month without coverage is a gap that is hard to close once it opens.
Rules vary by state — always check with yours
The federal law sets the framework, but every state designs its own reporting system, deadlines, exemption processes, and appeals process. What is true in one state may not apply in another. Only your state Medicaid agency can confirm exactly what you are required to do, what exemptions your state recognizes, and how to report correctly. If you are not sure, call the number on your Medicaid card or contact your health plan. Do not rely on general information alone — including this article — to make coverage decisions.
Bottom line: Not reporting — even when you are working or exempt — is one of the most common and most avoidable ways to lose Medicaid coverage. Know your status, document your hours, claim your exemption if you have one, and keep a copy of every confirmation. Use the Am I Exempt? tool to check whether the 80-hour rule applies to you at all.