Medicaid work requirements are an active and expanding policy development in 2026, and if you or someone in your household depends on Medicaid for health coverage, this shift may directly affect whether you stay enrolled. Several states are moving to implement or expand community engagement requirements as a condition of Medicaid eligibility. Understanding what these rules actually require, who is typically exempt, and what you can do to protect your coverage is the most practical place to start.

What Are Medicaid Work Requirements?

Medicaid work requirements — formally called "community engagement requirements" in federal waiver language — are rules that require certain Medicaid enrollees to document a minimum number of hours per month spent working, looking for work, attending school, participating in job training, or volunteering. These requirements do not apply to all Medicaid enrollees. They are typically targeted at able-bodied adults between the ages of 19 and 64 who are enrolled through Medicaid expansion and do not have dependents.

These requirements are not a new concept. Arkansas became the first state to implement them in 2018, but a federal court blocked enforcement before large-scale disenrollments could occur. What is different in 2025–2026 is the federal policy environment. The current administration has signaled strong support for approving Section 1115 demonstration waivers that include work requirements, giving states a clearer path to implementation than existed in recent years.

Data Snapshot

Medicaid currently covers approximately 72 million Americans, making it the single largest source of health coverage in the United States, according to enrollment data published by the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/data-research/statistics-trends-and-reports/medicaid-chip-enrollment-data.

The stakes of administrative reporting failures are well-documented. During the Arkansas pilot in 2018, more than 18,000 people lost Medicaid coverage within the first few months of enforcement. Subsequent analysis found that the majority of those individuals were either working or exempt — but had failed to complete the monthly reporting paperwork correctly. That finding is central to understanding the real-world risk these policies create: coverage loss driven not by ineligibility, but by paperwork.

Among the roughly 21 million adults enrolled through Medicaid expansion nationally, research has consistently found that 60 to 80 percent already work, are serving as caregivers, or face documented barriers to employment. The population actually subject to new requirements may be smaller than headlines suggest — but the reporting burden creates risk for a much broader group of enrollees.

Medicaid expansion eligibility is generally available to adults with household incomes at or below 138% of the Federal Poverty Level (FPL). Because FPL figures are updated annually, always verify current thresholds at https://www.healthcare.gov/glossary/federal-poverty-level-fpl/ rather than relying on dollar figures that may be outdated.

Which States Are Pursuing Work Requirements in 2026?

As of June 2026, the following states have either received CMS approval, submitted waiver applications, or publicly announced plans to pursue Medicaid work requirements:

  • Georgia — Already operating a limited Medicaid expansion program called "Georgia Pathways" that includes work requirements as a condition of enrollment.
  • Arkansas — Has reapplied for a work requirement waiver following the earlier federal court block.
  • Mississippi, Alabama, South Carolina, and Texas — Have introduced or advanced state legislation directing their Medicaid agencies to seek federal waivers.
  • Montana and Idaho — Have explored requirements tied to their Medicaid expansion populations.

This list is not exhaustive and is changing rapidly as waiver applications are submitted and legal challenges develop. The single most reliable source for your state's current status is your state Medicaid agency's official website. A directory of all state Medicaid agency contacts is available through https://www.medicaid.gov/about-us/contact-us/contact-state-page.html. Avoid relying solely on news reports, as approvals and court injunctions can change program status quickly.

Who Is Typically Exempt?

Every state's Section 1115 waiver is structured differently, but federal guidance and prior approved waivers have generally included exemptions for the following groups:

  • Pregnant individuals — typically for the duration of pregnancy and a defined postpartum period
  • Adults caring for a child under age 6 or a dependent with a disability
  • People with a documented physical or mental health condition that limits their ability to work
  • Full-time students enrolled in an accredited program
  • Participants in a job training or workforce development program, including SNAP Employment and Training (SNAP E&T)
  • People experiencing homelessness
  • Veterans — included in some state proposals
  • Adults age 55 and older — included in some state proposals

If you believe you fall into an exempt category, the burden is typically on you to document and report that exemption to your state Medicaid agency. This is where many people lose coverage unintentionally — not because they are ineligible for an exemption, but because they were unaware they needed to file paperwork to claim it.

What You Can Do Right Now to Protect Your Coverage

Regardless of whether your state has finalized work requirements, the following steps may help you stay informed and prepared.

Step 1: Confirm Your Contact Information Is Current

Your state Medicaid agency will notify you of any new requirements by mail or through your online account. If your mailing address, phone number, or email is outdated, you may miss critical notices entirely. Log in to your state's Medicaid portal or call your caseworker to verify your contact information as soon as possible.

Step 2: Understand Which Medicaid Category You're Enrolled Under

Work requirements typically apply only to adults enrolled through Medicaid expansion — sometimes called the ACA expansion population. They generally do not apply to: - Children enrolled in Medicaid or the Children's Health Insurance Program (CHIP) - Pregnant individuals - People who qualify for Medicaid based on a disability (SSI-related eligibility) - Seniors enrolled in Medicare-Medicaid dual coverage

Knowing your enrollment category helps you assess whether new rules are likely to affect you directly.

Step 3: Start Documenting Your Activities Now

If your state is moving toward work requirements, begin keeping a simple log of your work hours, job search activities, school enrollment, or caregiving responsibilities today — before any reporting deadline is announced. A basic spreadsheet or handwritten notes with dates and descriptions are sufficient. Reconstructing months of activity after a deadline is far harder than maintaining an ongoing record.

Step 4: Get Exemption Documentation on File

If you have a health condition, disability, or caregiving responsibility that may qualify you for an exemption, speak with your doctor or caseworker now about getting that documented in your Medicaid file. A letter from a treating physician or a copy of a dependent's birth certificate may be all that is required — but it needs to be on file before a reporting deadline is triggered.

Step 5: Know Your Appeal Rights

If you receive a notice that your Medicaid coverage is being terminated or reduced, you have the right to appeal. In most states, filing an appeal before the termination date allows you to maintain your coverage while the appeal is under review. The notice you receive must include instructions on how to appeal. Do not ignore termination notices, even if you believe the termination is an error.

What About Non-Expansion States?

If you live in one of the states that have not expanded Medicaid under the ACA — which as of mid-2026 includes Texas, Florida, and several others — work requirements tied to expansion may be less immediately relevant to you. However, coverage gaps in non-expansion states are already significant. Adults who earn too much for traditional Medicaid but too little to qualify for Marketplace premium subsidies may fall into a coverage gap with limited options.

For people in that situation, the following resources may be worth exploring:

  • CHIP (Children's Health Insurance Program) — if you have children under age 19, they may be eligible regardless of your state's expansion status
  • Federally Qualified Health Centers (FQHCs) — these federally funded clinics provide sliding-scale care regardless of insurance status; find one near you at https://findahealthcenter.hrsa.gov
  • State-specific limited coverage programs — some non-expansion states operate programs that may provide partial coverage for adults below certain income thresholds

Benefits.gov at https://www.benefits.gov allows you to search available programs by state and household situation, which may help you identify options you are not currently aware of.

If Your State's Work Requirement Is Blocked by a Court

Federal courts have previously issued injunctions blocking state work requirement waivers — most notably in Arkansas in 2019. If that happens in your state, enforcement is paused and people who lost coverage may be eligible for reinstatement. However, reinstatement is not always automatic. If you lose coverage due to a work requirement that is subsequently blocked, contact your state Medicaid agency directly to request reinstatement and ask about any deadlines for doing so.

Legal challenges to work requirement waivers are ongoing in multiple states, and the status of any given program can change. Staying connected to your state Medicaid agency — rather than relying on news coverage alone — is the most reliable way to know where things stand for your specific coverage.

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Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: June 2026