New Medicaid Work Requirements (June 2026 Rule): Who's Affected and How to Keep Your Coverage

On June 1, 2026, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule — CMS-2454-IFC, published in the Federal Register on June 3 — that requires most adults on Medicaid to complete 80 hours a month of work or "community engagement" to keep their coverage. It's the federal implementation of the Medicaid work requirement written into the 2025 budget reconciliation law, and it's the biggest change to Medicaid eligibility in years.

Nothing happens to your coverage today. The rule takes effect July 31, 2026, and states have until January 1, 2027 to put it in place — though a state can start sooner. What matters now is understanding whether the requirement applies to you, the four different ways to satisfy it, and the exemptions that may take you out of it entirely. Getting this wrong is how people lose coverage they were actually entitled to keep.

The work requirement applies to "applicable individuals" — CMS's term for non-pregnant adults between 19 and 64 who are not enrolled in Medicare and who get coverage through the Medicaid adult group (the expansion population) or certain section 1115 demonstration programs. CMS says 43 states and the District of Columbia cover these groups and will have to implement the rule. U.S. territories are not subject to it.

If you're on Medicaid through a different pathway — for example, as a child, as someone who qualifies on the basis of disability, or as someone who is also on Medicare (a "dual eligible") — the work requirement does not apply to you.

You meet the requirement for a given month if you do any of the following:

1. Log 80 hours of work or community engagement. Paid employment, self-employment, community service, or participation in an approved work program all count. You can combine activities — 50 hours of work plus 30 hours of community service gets you there.
2. Enroll at least half-time in an educational program. Half-time-or-more enrollment counts on its own.
3. Mix activities to reach 80 hours. Any combination of work, community service, work programs, and education that adds up to 80 hours in the month qualifies.
4. Earn the income equivalent. If your monthly income is at least 80 times the federal minimum wage — $580 a month in 2026 — you're treated as meeting the requirement even without separately documenting hours. Seasonal workers get a different calculation.

A long list of people are exempt and don't have to log hours at all. You're exempt if you are:

• Pregnant or in a postpartum period;
• A parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 or younger, or of a person with a disability;
• Medically frail or otherwise have special medical needs that significantly impair your ability to comply;
• An American Indian or Alaska Native;
• A veteran with a total disability rating;
• A former foster youth;
• Already meeting SNAP or TANF work requirements (and not exempt from them);
• Participating in a drug or alcohol rehabilitation or treatment program;
• An inmate of a public institution.

On top of those exemptions, states may choose to offer short-term hardship exceptions — for people receiving inpatient or nursing-facility care, those living in a county with a federally declared emergency or disaster, those in a county with high unemployment (at or above 8%, or 1.5 times the national average), and those traveling for an extended period to get serious or complex medical care. Whether these hardship exceptions exist depends on your state.

States must verify compliance at application and at renewal, and they have the option to check more often. If the state can't confirm you met the requirement, it has to send you a notice of noncompliance and give you 30 calendar days to either show that you complied or show that you're exempt.

If you don't respond in time, your application can be denied or your coverage can be terminated. The good news: you can reapply at any time, and you'll be reassessed for compliance when you do. But a gap in coverage — even a short one — can leave you exposed to the full cost of any care you need in the meantime, which is exactly the situation these calculators exist to help you avoid.

Losing Medicaid coverage — whether because of the work requirement or any other reason — generally opens a Special Enrollment Period on the ACA Marketplace. That gives you a window (typically 60 to 90 days) to enroll in a Marketplace plan, often with a premium tax credit that lowers your monthly premium depending on your income. For many people who age out of Medicaid eligibility, a subsidized Silver or Bronze Marketplace plan is the next-cheapest landing spot.

The move to make before any coverage ends is to price it out. Run your expected income through an ACA subsidy estimator so you know what a Marketplace plan would cost and aren't caught off guard by a gap.

1. Figure out if the requirement applies to you. Are you a non-pregnant adult 19–64 on expansion Medicaid and not on Medicare? If not, you can stop here.
2. Check the exemption list. Caregiver of a young child, medically frail, veteran with a total disability rating, AI/AN, already meeting SNAP/TANF rules — any of these takes you out of it.
3. If you're subject to it, pick your easiest path. If you already earn at least $580 a month, lean on the income option and confirm your state has your income on file. Otherwise, line up 80 hours a month of work, school, or community service and keep records.
4. Watch your mail and your state portal. The 30-day noncompliance notice is the most important piece of paper you'll get — don't ignore it.
5. Have a fallback priced out. If you think you might lose coverage, know your Marketplace cost before the gap starts.

The June 2026 Medicaid work-requirement rule won't touch your coverage immediately, but it sets a clock running toward January 1, 2027. If you're a working-age adult on expansion Medicaid, the safest thing you can do over the next few months is confirm whether you're exempt, and if you're not, settle on a clean way to show 80 hours a month — or $580 of monthly income. Keep your contact information current with your state so the noncompliance notice actually reaches you, and price out a Marketplace plan as a backstop. The rule is administrative; the consequences of missing a notice are not.