The 80-hour work rule

Public Law 119-21, which CMS calls the "Working Families Tax Cut" legislation, adds a requirement called community engagement for some adults on Medicaid. Most people call it the work rule.

Who it applies to

It applies to adults ages 19 to 64 who get Medicaid through the expansion (the adult group) and aren't exempt. It doesn't apply to children, people on Medicare, or people who get Medicaid another way, such as through a disability or pregnancy. A long list of people are exempt; the next lesson goes through them and has a checker.

When it starts

States must start the rule by January 1, 2027, and they can start earlier. Nebraska started on May 1, 2026, and Montana and Arkansas on July 1, 2026 (Arkansas won't end anyone's coverage for it before January 1, 2027). Iowa starts December 1, 2026. Georgia's Pathways program has had its own work rule since 2023.

How to meet it

You need a combined 80 hours a month from any mix of:

• Work, including self-employment
• Community service or volunteering
• A work program, such as job training

Going to school at least half time also counts on its own. So does earning at least what 80 hours at the federal minimum wage would pay, which is $580 a month.

When you apply, your state can ask you to show you met the rule for 1 to 3 months before you applied. After that, it will check again at renewal.

How your state checks

States must first try to confirm that you meet the rule, or that you're exempt, using information they already have, such as wage records. If they can't, CMS says they must send you a notice and give you 30 calendar days to show you meet it or that you're exempt. States also have to tell people about the rule before it starts.

Read every letter from your Medicaid agency between now and next year, keep your address up to date, and answer by the deadline.

Sources: Community engagement, Medicaid.gov; Community engagement interim final rule, Federal Register; CMCS bulletin on the Medicaid provisions of Public Law 119-21, CMS.