Medicaid work requirements: dates and what to send

If you get Medicaid as an adult through your state’s Medicaid expansion, a federal law passed in July 2025 adds a condition: 80 hours a month of work, school, volunteering or a work program, or an exemption. Most states start in January 2027, and most will ask again every six months. Here is when your state starts, what counts, what to keep and where to send it.

1. Which states start when

Iowa is first. Dates differ by state, and in several states they differ for people applying and people renewing, so the table gives each date as the state publishes it, linked to the state’s own page. Your notice is the final word on your own date.

* These four states count three months of activity in each review period, not one. North Carolina’s page says you meet the requirement “for only 3 of the 6 months before your recertification.” Kentucky’s says “at least three of the six months before you renew your coverage.”

Three states have already started: Nebraska, Montana and Arkansas. Michigan, Illinois and Idaho tie the start to your renewal rather than to one date for everyone.

2. What counts

The federal rule comes from the Centers for Medicare & Medicaid Services. It applies to adults 19 to 64 in the Medicaid expansion group who are not on Medicare, and it says states must start it “beginning January 1, 2027.” In any month, one of these counts:

• “Work at least 80 hours.”
• “Complete at least 80 hours of community service.”
• At least 80 hours in a work program
• School or career and technical education at least half-time
• Any mix of those that adds up to 80 hours
• Monthly income of at least the federal minimum wage times 80 hours, which CMS puts at “$7.25 x 80 = $580 per month”

You are exempt if you are:

• A parent or caregiver of a child 13 or under, or of a person with a disability
• Medically frail, which includes being blind or disabled, having a substance use disorder or having a serious or complex medical condition
• Pregnant or postpartum
• American Indian or Alaska Native
• A veteran with a total disability rating
• A former foster youth under 26
• Meeting a SNAP or TANF work requirement
• In a drug or alcohol treatment program
• Released from jail or prison in the last three months

A state can ask for more time if it is making a good-faith effort. CMS says those exemptions “must expire no later than December 31, 2028.”

3. What you will be asked to send

Most states check wage, tax and benefit records first and ask you for proof only when they cannot confirm. New Jersey says it plainly: “you do not need to send documents unless NJ FamilyCare asks for them.” Start keeping papers now and send what your notice asks for.

What state pages name as proof:

• A job. Ohio lists “Paycheck stubs showing your last 30 days of income” and a “Letter from employer providing hourly wage, hours worked, and pay frequency.” New Jersey takes “pay stubs, timesheets, or a letter from your employer.”
• Gig work or self-employment. New Jersey takes “an hours report from the app, earnings statements, 1099s, or a Profit and Loss Statement.” Montana names tax returns.
• School. Oregon takes a “Class schedule, financial award letter, or a statement from your school or program.”
• Volunteering or a work program. Ohio asks for a “Letter from organization providing scheduled hours and begin date.” Oregon takes “Timesheets, activity logs, statements from employers, schools, or volunteer organizations.”
• An exemption. Ohio names a “Doctor’s Statement,” a “Disability Award Letter” and a “Letter confirming number of hours assistance/care is provided.”

Louisiana uses its own verification form, signed by your boss, teacher or volunteer supervisor. Its page says pay stubs that show your hours can be sent instead.

For 2027, some states let you state some of this yourself. Colorado says “self-attestation may be used” for medical frailty, student status, volunteer work and work programs. New Jersey lets you confirm volunteering and job training yourself, adding “Starting in 2028, you may need to send us documents as proof.” Louisiana: “For 2027 renewals, members can self-attest that they meet these exemptions.”

4. Where it goes

Use your state’s online account first if it has one, such as Ohio’s Self-Service Portal, kynect in Kentucky, MI Bridges in Michigan or CommonHelp in Virginia. Mail works in every state, and your notice gives the address.

Fax is the other route, and states differ on what it takes:

• Louisiana lists fax as one way to send proof for the work requirement, next to online, email, mail and in person. Its number is in the directory.
• New Mexico lists fax among the ways to send documents at renewal. See the directory.
• Nebraska lists a fax line for information the department asks you to send. Its work requirement page names other ways to answer that notice, so follow yours. See the directory.
• Idaho, Montana, Oregon and Utah publish a fax line for renewal or verification documents. Their pages do not say it takes work requirement proof, so check your notice before you use it.

Every state’s number, where one is published, is on Medicaid fax numbers by state with the page it came from. Most states publish none, since documents go to a county office, and that page links the agency instead.

5. Six-month renewals

The same law moves most expansion adults from yearly renewals to renewals every six months, “beginning with renewals initiated on or after January 1, 2027,” in CMS’s words. Most states on the list above say January 2027. Oregon says “late 2027.” North Carolina, New Jersey, Virginia and Washington keep American Indian and Alaska Native members on a 12-month renewal.

Expect the same request for proof twice a year, and keep each month’s pay stubs, schedules and logs together.

6. Send a test fax first, then the real one

If you are faxing, send a test fax first. It is a normal $2.99 send to a ProntoFax test line that shows you the pages as they arrived, so you can check every page is readable before the real one goes out. ProntoFax sends faxes and does not receive them, so any reply from your state comes by mail, by phone or through your online account.

Keep the receipt email from the real send. It shows the full number you sent to, the time it was delivered and the page count. When a caseworker says a document never arrived, that is what they ask for.

7. If you miss the date

• Federal rule. If a state cannot confirm you met the requirement, it must send a notice and give you “30 calendar days from the date such notice is received” to show you met it or that you are exempt.
• Louisiana. You have 45 days to respond to a renewal packet. If you lose Medicaid only because of the work requirement and then start working, “you may reapply to gain coverage after you have worked for one month.” You can also appeal.
• New Jersey. If your coverage ended because you did not answer a letter, “you have 90 days from the day your coverage ends to send NJ FamilyCare the missing information,” with no new application.
• Most states. Arkansas, Illinois, Kentucky, Michigan and North Carolina all say you can reapply. Your notice explains how to ask for a hearing.

This note is about getting proof to the right place, not advice about whether you are exempt. If you are unsure, call the number on your notice.

Sources

• Centers for Medicare & Medicaid Services, informational bulletin on the community engagement requirements, Dec. 8, 2025. https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf
• Centers for Medicare & Medicaid Services, fact sheet, “Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period,” June 1, 2026. https://www.cms.gov/newsroom/fact-sheets/medicaid-community-engagement-requirement-certain-individuals-interim-final-rule-comment-period-cms
• Medicaid.gov, “Community Engagement.” https://www.medicaid.gov/resources-for-states/working-families-tax-cut-legislation/community-engagement
• Iowa Department of Health and Human Services, Iowa Health and Wellness Plan community engagement requirements. https://hhs.iowa.gov/medicaid/plans-programs/iowa-health-wellness-plan/ihawp-community-engagement-requirements
• Arizona Health Care Cost Containment System, “H.R. 1.” https://www.azahcccs.gov/AHCCCS/Initiatives/HR1/
• Colorado Department of Health Care Policy and Financing, “Work Requirements FAQs.” https://hcpf.colorado.gov/work-requirements-faqs
• Indiana Family and Social Services Administration, Healthy Indiana Plan work requirements, information for members. https://www.in.gov/fssa/hip/hip-work-requirements/info-for-hip-members
• Kentucky Health Benefit Exchange, “Medicaid Changes.” https://khbe.ky.gov/Enrollment/Pages/MedicaidChanges.aspx
• Louisiana Department of Health, “Medicaid Work Requirements.” https://ldh.la.gov/medicaid/work-requirements
• New Jersey Division of Medical Assistance and Health Services, “Work Requirements.” https://www.nj.gov/humanservices/dmahs/obbba/work-requirements/index.shtml
• North Carolina Medicaid, “The Work and Community Engagement Requirement.” https://medicaid.ncdhhs.gov/beneficiaries/impact-hr-1-and-federal-changes-medicaid/nc-medicaid-work-and-community-engagement-requirements
• Ohio Department of Medicaid, “Group VIII Partner Packet,” Version 2, August 2026. https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families,%20Individuals/Programs/Community/Group_VIII_Partner_Packet_08132026.pdf
• Utah Medicaid, H.R. 1 changes. https://obbba.medicaid.utah.gov
• Virginia Department of Medical Assistance Services, H.R. 1 federal work requirements one-pager. https://www.dmas.virginia.gov/media/3cqdm2wa/hr1-federal-work-requirements-one-pager.pdf
• Washington Health Care Authority, “Apple Health (Medicaid) Work Requirements.” https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/apple-health-medicaid-work-requirements
• Michigan Department of Health and Human Services, “New Medicaid Work Requirements.” https://www.michigan.gov/healthymiplan/new-medicaid-work-requirements
• Illinois Department of Healthcare and Family Services, H.R. 1 phase 2 toolkit. https://hfs.illinois.gov/content/dam/soi/en/web/hfs/info/fedresctr/englishhr1phase2toolkit.pdf
• Idaho Department of Health and Welfare, “Medicaid Expansion.” https://healthandwelfare.idaho.gov/services-programs/medicaid-health/medicaid-expansion
• Oregon Health Authority, federal changes to the Oregon Health Plan. https://www.oregon.gov/oha/hsd/ohp/pages/federal-changes.aspx
• New Mexico Health Care Authority, Medicaid member guide to the new requirements. https://www.hca.nm.gov/wp-content/uploads/HCA_HR1_MED_MemberJourney_13.pdf
• New Mexico Health Care Authority, Keep Your Benefits New Mexico. https://www.hca.nm.gov/keepyourbenefitsnm/
• Arkansas Department of Human Services, Arkansas Health and Opportunity for Me community engagement FAQ. https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/arhome/arhome-community-engagement-requirement/arhome-faq/
• Montana Department of Public Health and Human Services, Medicaid changes FAQs. https://dphhs.mt.gov/medicaidchanges/faqs
• Nebraska Department of Health and Human Services, work requirements. https://dhhs.ne.gov/workrequirements