Medicaid Work Requirement Notice (2026)

This is the first step. Most people in Medicaid DO qualify for an exemption, but many don't realize it. If you qualify, you don't need to prove 80 hours of work.

You may be exempt if you are:

• Disabled or have a serious medical condition — You cannot work due to physical or mental health limitations
• Pregnant — You're currently pregnant and cannot work due to pregnancy complications
• Parent or caregiver of a dependent child — You're the sole caregiver for a child or dependent
• Full-time student — You're enrolled full-time in a college, university, or accredited school
• Veteran — You have military service (applies to most veterans)
• In an approved training program — You're enrolled in job training, apprenticeship, or vocational program
• Homeless or experiencing unstable housing — You lack stable housing and cannot work reliably

If ANY of these apply to you, skip to Step 3 to gather documentation.

You likely already meet the requirement. Here's how to prove it:

• Gather pay stubs from the last 2-3 months showing hours worked
• Calculate your monthly hours: Add up all hours from last month. If it's 80 or more, you're covered
• Get employer contact info — The state may verify directly with your employer
• Include written statement — "I am employed by [company] and work approximately [X] hours per month"

Gig work counts! If you do DoorDash, Uber, Instacart, TaskRabbit, or freelance work, save your payment records. These show hours worked and income.

Get documentation NOW. Do not assume the state knows about your situation. You must PROVE it.

• Medical exemption: Get a letter from your doctor describing your functional limitations (what you cannot do due to your condition). Include diagnosis if possible
• Student exemption: Get a letter from your school on official letterhead stating you're enrolled full-time
• Veteran exemption: Get your DD-214 (discharge papers) from your records or the VA
• Caregiver exemption: Gather birth certificates, custody documents, or legal guardianship papers for the dependent you care for
• Pregnancy exemption: Get verification from your OB/GYN or doctor
• Homeless exemption: Contact your local social services or homeless services organization

Call your doctor, school, or employer TODAY. Don't wait.

You have options:

• Ask your employer for more hours — Can you pick up extra shifts? Work additional days?
• Add a second job or gig work — 20-30 hours at a second job can get you over 80 total
• Enroll in an approved training program — Some states count vocational training or apprenticeships toward the requirement
• Document all work hours — Even if you don't reach 80, document what you do work. Some states have hardship exemptions for people trying but unable to reach 80
• Apply for an exemption — If increasing hours is genuinely impossible, document why and apply for hardship or medical exemption

You must submit either work documentation OR exemption documentation by the deadline on your letter (usually 30 days from the letter date).

• Check your letter for submission instructions — Mail, fax, online portal, or in-person
• Make copies of everything — Keep originals for your records
• Include a cover letter: "I am submitting proof of [work hours / exemption] per the notice dated [date]. My case number is [number]."
• Keep proof of submission — Get a confirmation number or receipt
• Follow up within 1 week — Call your state Medicaid office to confirm they received your submission

30 days is NOT a soft deadline. Your Medicaid will be terminated if you don't respond.

• Traditional employment — W-2 jobs, any hours worked and paid
• Self-employment — Business income, freelance work, consulting
• Gig work — DoorDash, Uber, Lyft, Instacart, TaskRabbit, Fiverr, Upwork, etc. (use payment records as proof)
• Apprenticeships — Registered apprenticeship programs with paid work
• Vocational training — If the state specifically approves it (call and ask)
• Volunteering — Some states count approved volunteering; most do NOT. Call your state to verify

• Unpaid family work — Working in a family business without pay
• Job searching — Time spent looking for work does not count as work hours
• Training without paid work — Some unpaid internships or training may not count
• Volunteering — Usually does not count, unless your state specifically approves it

Bottom line: If you get paid (W-2, 1099, cash payment, app payment), it counts. If you don't get paid, it usually doesn't count unless it's an approved exemption or training program.

• You lose Medicaid because you didn't submit work proof or exemption documentation
• Your state reports this "voluntary" termination to HealthCare.gov
• HealthCare.gov makes you INELIGIBLE for ACA premium tax credits and cost-sharing reductions
• You cannot switch to a subsidized marketplace plan for the rest of the year
• You face full-price health insurance with no financial help (often $400-$1,000+/month for individual plans)
• Or you go uninsured and face medical debt if you need care

This creates a cliff where people fall through BOTH safety nets at once.

• Document your exemption THOROUGHLY. If you have a medical condition, get a detailed doctor's letter. If you're a caregiver, get custody papers. Do not assume the state understands your situation.
• Submit by the deadline. Do not miss it. Late submissions may not restore your coverage.
• If you lose Medicaid and believe it was in error, appeal immediately. You have appeal rights. Request Legal Aid assistance if needed.
• Contact a Medicaid navigator or legal aid organization if you're at risk of non-compliance. They can help you gather documentation and advocate for exemptions.
• Monitor your Medicaid status. Check your eligibility 1 week before the deadline. If it shows termination pending, you have a window to submit proof.

As of 2026, approximately 18 states have implemented or are implementing OBBBA 2025 work requirements. Rules vary significantly:

• Strict enforcement states: Enforce requirements rigorously and terminate coverage quickly for non-compliance
• Moderate states: Enforce but allow hardship exemptions and offer phase-in periods
• Phase-in states: Gradually roll out requirements with grace periods for compliance

Your state's specific rules matter enormously. Some states have hardship exemptions if you can't reach 80 hours. Others require strict compliance. Some count education or training toward the requirement. Others don't.

You MUST call your state Medicaid office to understand YOUR state's specific rules. Don't assume based on another state's policy.