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A guide only, based on CMS's description of the rule. Your state decides who is exempt and how you show your hours. States can also excuse some short-term hardships; ask your Medicaid agency.
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How it works
The rule, called community engagement, applies to adults ages 19 to 64 who get Medicaid through the expansion (the adult group) and are not exempt. It does not apply to children, people on Medicare, or people who get Medicaid another way, such as through a disability or pregnancy.
To meet it you need a combined 80 hours a month from any mix of work, community service or volunteering, and a work program such as job training. Going to school at least half time also counts on its own, as does earning at least what 80 hours at the federal minimum wage would pay, which is $580 a month.
States must start by January 1, 2027, and they can start earlier. When your state can't confirm you meet the rule or are exempt from information it already has, it must send a notice and give you 30 calendar days to respond.
This is an estimate, not a decision. KPCB Edge is an independent publisher, not a government agency, and only the agency that runs the program can decide whether you qualify.
Good to know
CMS lists these groups as excluded: pregnant and postpartum women; parents, guardians and caretaker relatives of a child 13 or under or of a person with a disability; people who are medically frail, including people who are blind or disabled; former foster youth under 26; American Indians and Alaska Natives eligible for Indian Health Service care; veterans with a total disability rating; and people who already meet TANF work requirements or SNAP work rules.
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.
Read every letter from your Medicaid agency, keep your address up to date and answer by the deadline. A letter from your doctor, your child's birth certificate, or proof of your SNAP or TANF case usually shows an exemption.
No. It gives a rough answer from what you tick. Only your state Medicaid agency can decide whether the rule applies to you.
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