Medicaid Work Rules Finalized: Who Must Work and What Counts

The CMS has issued final Medicaid work rules targeting expansion enrollees, requiring 80 hours of qualifying activities per month (work, college courses, volunteering, or in‑kind work) with exemptions for children, pregnant people, and those who are medically frail or on Social Security disability. Initially, enrollees can self-attest and states will use available data to verify activity, but proof may later be required. The rules launch in most states by January 2027, with some states starting sooner; Arkansas, Nebraska, and Montana have noted phased approaches. While the aim is to curb fraud and extend coverage to those in need, there are concerns about administrative burden and potential loss of coverage for those unable to prove participation. Enrollees should update addresses and monitor state Medicaid notices for updates.