What You Need to Know About Medicaid Work Requirements

Under the One Big Beautiful Bill Act (H.R. 1), many adults on Medicaid will soon need to regularly show proof of working, volunteering, or attending school to keep their Medicaid coverage. This change is known as work requirements, or “community engagement requirements,” and will take effect January 1, 2027.

At Fortuna, our mission is to make Medicaid easier to navigate for the people who depend on it. That means keeping you informed before changes affect your coverage.

Here's what's changing and what to do to prepare.

What Are Work Requirements?

Starting January 1, 2027, adults ages 19 to 64 will need to complete and show proof of at least 80 hours per month of qualifying activities.

Activities that count toward the 80-hour requirement:

• Paid employment
• Volunteering or community service
• Seasonal work
• School or educational programs
• Job training programs

Any combination of these activities counts. As long as they add up to 80 hours in a month, you're meeting the requirement.

How Are Hours Calculated?

If you have a paying job, your 80 hours can be counted in one of two ways:

• By hours worked: Hours-based participation counts the number of hours you worked that month.
• By earnings: Earnings-based participation takes your earnings from the month divided by the federal minimum wage ($7.25/hour). This means if you earned at least $580 in a month (the equivalent of 80 hours of wages), you've met the requirement, even if you worked fewer than 80 hours.

The earnings-based option is especially relevant for people who work irregular schedules, or earn more per hour and work fewer hours.

Understanding Exemptions

Not everyone will have to meet the work requirements. You may be exempt if any of the following applies to you:

Family & Caregiving

• You're pregnant or gave birth in the last 12 months
• You care for a child under 14, or help someone with daily needs (such as a disabled person or older adult)
• You have a child between 14 and 18, and your household income is below 53% of the Federal Poverty Limit (FPL)

Health & Disability

• You have a physical, intellectual, or developmental disability that makes everyday tasks difficult
• You have a serious ongoing health condition like heart failure, kidney disease, or an autoimmune disorder
• You're living with a mental health condition like depression, schizophrenia, or OCD
• You’re living with, or in treatment for, a substance use disorder

Medical Care

• You were in a hospital, nursing home, or similar care facility last month
• You had to travel outside your community for medical care last month, for yourself or a dependent

School & Other Programs

• You're enrolled in school or a job training program at least half-time
• You already have a work requirement through food stamps (SNAP) or cash assistance (TANF)

Special Circumstances

• You were in foster care at age 18 and are still under 26
• You're a veteran with a 100% disability rating
• You are currently incarcerated, or were in the last 3 months

If any of these apply to you, you may qualify as exempt from work requirements. To request an exemption, you’ll need to provide your state with supporting documents, such as a medical record or document confirming your caregiving role.

What Should I Do to Prepare?

States are currently building out processes for members to report hours or request exemptions. While states are required to begin enforcing Medicaid work requirements January 1, 2027, some states are moving sooner. Nebraska, for example, will begin enforcing work requirements starting May 1, 2026.

To stay on top of your coverage, here’s how you can prepare:

1. Keep an eye out for mail from your state

Between June 30 and August 31, 2026, your state Medicaid agency is required to notify you about work requirements by mail and at least one additional method, such as a text message or email. This notice will explain how to report your hours, who qualifies for an exemption, and what happens if you miss the requirement. Keep an eye out for this piece of communication so you can refer to it when work requirements take effect in 2027.

2. Check if you're exempt and gather your paperwork

If you think you qualify for an exemption, start collecting supporting documents now: medical records, a letter from your doctor, school enrollment confirmation. Having these ready ahead of time will make the process smoother when requirements kick in.

3. Find opportunities to meet the requirement

If you are unsure how to reach 80 hours, local nonprofits, community centers, and workforce development programs are good places to start to find opportunities. Your state may also have resources to connect you with qualifying activities in your area. Remember that volunteering, community service, and part-time work all count toward your 80 hours.

What Happens If I Don't Meet the Requirement?

If you do not meet the requirement in a given month, your state will send you a notice. You will then have 30 days to explain your situation or provide any missing documentation.

If you do not respond within that window, you could lose your Medicaid coverage the following month. When a notice arrives, the best thing you can do is take action and respond promptly.

At Fortuna, we believe every member deserves clear, timely support to navigate what's coming. We'll continue to track Medicaid policy changes and share what you need to know.

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