Medicaid Work Rules Finalized: Who Must Work and How to Prove It

CMS has finalized work rules for certain Medicaid enrollees, affecting about 18.5 million people in expansion populations. Exemptions apply to children, pregnant people, those already receiving Social Security disability benefits, and medically frail individuals, though documentation and state decisions may tighten protections. Initially, states can rely on automated data or self-attestation; later, more proof may be required. Qualifying activities include 80 hours of work per month or alternatives like college enrollment, volunteering, or in-kind work. States must inform enrollees by mail or digital means, and rollout begins in January 2027 (with some states launching earlier). Enrollees should update contact info and check with their state Medicaid agency for specifics, as missteps could lead to coverage loss.