Medicaid work requirements (H.R.1): what they are, who's affected, and what to do
H.R.1 — also called the One Big Beautiful Bill Act (OBBBA), signed July 4, 2025 — requires many Medicaid expansion adults (generally ages 19–64) to complete about 80 hours a month of work, school, job training, or community service, and to report it — unless they qualify for an exemption. States must implement the requirement by January 1, 2027. Here's what it means, and what members, health plans, and states should do.
What is required?
Many Medicaid expansion adults must complete and report about 80 hours per month — roughly 20 hours a week — of qualifying activity to keep their coverage. Qualifying activity includes:
- Work — employed or self-employed.
- Education — school, including students enrolled at least half-time.
- Job training — workforce or vocational programs.
- Community service / volunteering.
These can be combined to reach 80 hours (for example, 40 hours of work plus 40 hours of training). The activity generally must be reported to the state each month. Members who qualify for an exemption do not have to report hours.
Who is affected — and who is exempt?
The requirement applies mainly to Medicaid expansion adults, generally ages 19–64. Many people are exempt, including caregivers of a child under 14, pregnant and postpartum members, people with a disability or who are medically frail, people in substance-use-disorder treatment, American Indian and Alaska Native members, students, and people facing a short-term hardship.
Many eligible people are exempt and don't realize it — and that's the biggest risk. See the full exemption guide → or check if you're exempt →
The Medicaid work requirement timeline (2025–2028)
- July 4, 2025 — H.R.1 / OBBBA signed into law.
- December 8, 2025 — CMS issues an Informational Bulletin on implementation.
- June 1, 2026 — CMS Interim Final Rule (CMS-2454-IFC).
- June 30 – August 31, 2026 — Federally-mandated enrollee-notice window: states must notify members by mail plus at least one additional channel, covering compliance, exemptions, consequences, and reporting.
- January 1, 2027 — States must implement community-engagement requirements; federal enforcement begins.
- Through December 31, 2028 — Good-faith implementation extensions are possible.
Separately, OBBBA shortened the eligibility redetermination cycle for expansion adults from once a year to every six months — doubling the moments a member can fall off coverage. More on the six-month renewal →
How to keep your Medicaid
- Watch for your state's notice (it will arrive by mail and at least one other channel between June 30 and August 31, 2026).
- Check if you're exempt — many people are. Use the free checker, then confirm with your plan or state.
- If you're not exempt, report your ~80 hours a month the way your state asks. Here's how →
- Never drop your coverage based on an online tool. Only your state can confirm your status; ask your health plan or state Medicaid office if you're unsure.
Common questions
What are the Medicaid work requirements under H.R.1?
H.R.1 / OBBBA (signed July 4, 2025) requires many Medicaid expansion adults (generally 19–64) to do and report about 80 hours a month of work, education, job training, or community service, unless exempt. States must implement by January 1, 2027.
How many hours do you have to work for Medicaid?
About 80 hours a month — roughly 20 hours a week — of work, school, training, or volunteering, in any combination. Exempt members don't report hours.
When do the requirements start?
States must implement by January 1, 2027 (federal enforcement begins). A federal enrollee-notice window runs June 30–August 31, 2026. Good-faith extensions are possible through December 31, 2028.
What counts toward the requirement?
Work, school/education, job training, and community service — combinable to reach ~80 hours/month, reported to your state.
How do I keep my Medicaid under the new rules?
Report ~80 hours a month, or claim an exemption if you qualify. Watch for your state's notice, respond on time, and ask your plan or state office if unsure. Don't drop coverage based on a tool alone.
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