The Centers for Medicare and Medicaid Services (CMS) has issued an Interim Final Rule regarding new requirements that certain adult Medicaid applicants and prospective enrollees meet an 80-hour per month work requirement as a condition for eligibility. The rule implements this new requirement created by last year’s One Big Beautiful Bill Act (OB3).
Under the new regulation, certain adults will need to complete 80 hours of a “qualifying activity” each month to keep their Medicaid coverage. The requirement applies to adults ages 19 through 64 covered through Medicaid expansion in the 40 states and the District of Columbia that have expanded coverage.
A person can meet the requirement through work, community service, enrollment in an educational program at least half-time, or participation in a work program, and can also qualify by combining activities or by earning a monthly income at or above the federal minimum wage.
The rule sets exemptions for groups, including people who are pregnant or postpartum, people who are disabled or medically frail, caregivers of young children, American Indian and Alaska Native individuals, and people already meeting work requirements under SNAP or TANF. In addition, for the initial year of the rule, individuals can self-attest to qualifying medical conditions and meet community engagement requirements until January 2028, at which point states would be required to verify those conditions.
States must implement the requirement no later than January 1, 2027, and comments on the proposal are due July 31, 2026.
Impact on the Public Workforce System
States must verify each month that enrollees are meeting the requirement, and the rule defines a qualifying work program to include programs under Title I of the Workforce Innovation and Opportunity Act (WIOA). CMS encourages states to coordinate with their workforce agencies on data sharing and on aligning job search activities, which places part of the verification and documentation burden on workforce programs that local boards oversee.
Read the interim final rule and CMS fact sheet here.
Member Portal