New federal Medicaid work-reporting requirements are expected to take effect nationwide on January 1, 2027. These changes could affect many adults who receive Medicaid through an expansion program—particularly people whose work schedules or weekly hours fluctuate.
A recent study highlighted by the Boston University School of Public Health found that nearly 1 in 5 Medicaid-eligible adults in expansion states could be at risk of not meeting the new requirements because of insufficient or inconsistent work hours.
What are the new requirements?
Under the new federal rules, certain adults enrolled through Medicaid expansion may need to show that they spend at least 80 hours per month participating in qualifying activities. These activities may include:
- Working
- Volunteering
- Attending school
- Participating in an approved job-training program
Some individuals may qualify for an exemption. Because eligibility rules and reporting procedures can vary, Medicaid members should pay close attention to notices from their state Medicaid agency.
Why could working adults lose coverage?
Not everyone has a predictable work schedule. People working in retail, hospitality, food service, healthcare, agriculture, or the gig economy may have their hours reduced or changed from week to week.
Other circumstances – including transportation problems, childcare responsibilities, chronic health conditions, or an employer’s scheduling decisions – may also affect someone’s ability to reach or document the required number of hours.
According to the Boston University article, more than two-thirds of the Medicaid recipients examined were participating in the labor force. Among that group, most were working more than 35 hours per week on average. However, inconsistent schedules could still put some working adults at risk of losing coverage.
How can Medicaid members prepare?
If you currently receive Medicaid, consider taking these steps:
- Keep your contact information updated. Make sure your state Medicaid agency has your current address, phone number, and email.
- Read every Medicaid notice. Do not ignore letters, emails, or online account notifications about eligibility or reporting.
- Save documentation. Keep pay stubs, work schedules, school enrollment records, volunteer records, and job-training documentation.
- Ask whether you qualify for an exemption. Exemptions may apply based on age, disability, caregiving responsibilities, pregnancy, or other circumstances.
- Respond by the stated deadline. Missing a reporting or renewal deadline could interrupt your coverage.
- Seek assistance early. Contact your state Medicaid office or an approved benefits navigator if you are unsure what information to submit.
Patriot Pharmacy is here to help
Changes in insurance coverage can also affect prescription costs and access to medication. If your coverage changes, contact Patriot Pharmacy before skipping a medication or delaying a refill. Our pharmacy team can help you understand your prescription options and discuss available cost-saving resources when appropriate.
For complete details on the research, read the original article from the Boston University School of Public Health.
This article is provided for general educational purposes and does not constitute legal, medical, or insurance advice. Medicaid requirements and exemptions may vary. Contact your state Medicaid agency or a qualified benefits professional for guidance about your eligibility.
