Most states do not have work requirements for Medicaid, but some do — and the rules vary widely by state and by which program you are in.

Work requirements are conditions that say you must work, look for work, or do other activities to keep your Medicaid coverage. As of now, fewer than half of U.S. states have them, and they explore to different age groups and different Medicaid programs depending on where you live. Some states have had them for years; others added them recently or removed them. The federal government allows states to set their own rules on this, so your state's requirement depends entirely on state law, not federal Medicaid law.

If you live in a state with work requirements, the rules usually exempt certain groups: children, pregnant people, people over 65, people receiving disability benefits, and people caring for a dependent. But the groups that do face requirements, and what counts as meeting them, differ from state to state.

Key Takeaways

  • Work requirements exist in some states but not others, and they explore to different groups depending on which Medicaid program you are in and your state's rules.
  • Common exemptions include children, pregnant people, people over 65, people with disabilities, and primary caregivers, though exemption rules vary by state.
  • Work, job training, volunteer work, and school attendance can all count toward meeting a requirement, depending on your state's definition.
  • If you do not meet a work requirement, you lose Medicaid coverage, though most states have a process to restore it once you meet the requirement again.
  • Your state's Medicaid office or your state health department website will tell you whether your state has work requirements and who they explore to.

Which states have work requirements right now

As of early 2024, roughly 18 to 20 states have some form of work requirement in place, though the exact number changes as states add or remove them. States that have had them include Arkansas, Arizona, Indiana, Kansas, Kentucky, Mississippi, Missouri, Montana, New Hampshire, North Carolina, Ohio, Tennessee, Texas, Utah, Virginia, and Wisconsin. Some of these states paused or removed their requirements during the COVID-19 pandemic and have since restarted them; others added them more recently.

The best way to know whether your state has a work requirement is to visit your state's Medicaid website or call your state Medicaid office directly. Your state health department can also tell you. Do not assume based on what you hear about another state — the rules change frequently and differ significantly from one state to the next.

Who is exempt from work requirements

Most states that have work requirements exempt certain groups automatically. These typically include children under a certain age (often 18 or 19), pregnant people, people over 65, people receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), and people who are the primary caregiver for a child or dependent adult. Some states also exempt people with serious medical conditions, people experiencing homelessness, or people in substance abuse treatment.

The exact list of exemptions depends on your state and sometimes on which Medicaid program you are in. If you think you may be exempt, ask your state Medicaid office which exemptions explore to you. Do not assume you are exempt based on your situation — the definitions are specific and vary.

What counts as meeting a work requirement

States define "work" differently, but most accept several types of activity. Working at least 20 hours per week at a paying job is the most common way to meet a requirement. But most states also count job training programs, vocational rehabilitation, community service or volunteer work, school attendance (including high school, college, or GED programs), and participation in work-search activities like job counseling or resume writing.

Some states count caring for a child under a certain age as work. Others count participation in substance abuse or mental health treatment. The key is that your state defines what counts, and you need to know your state's specific list. Your state Medicaid office can tell you what activities satisfy the requirement in your state.

What happens if you do not meet the requirement

If you do not meet your state's work requirement, you lose Medicaid coverage. Your coverage typically ends at the end of the month in which you failed to meet the requirement, though the exact timing depends on your state's rules. You will receive notice before your coverage ends, usually giving you time to report that you have started meeting the requirement and restore your coverage.

If you lose coverage and then start meeting the requirement again, you can usually restore your coverage by reporting your activity to your state Medicaid office. Most states have a process to reinstate you quickly once you show you are meeting the requirement. You do not have to reapply from scratch — you straightforward report the change and your coverage resumes.

How to report your work activity

Your state Medicaid office will tell you how to report that you are meeting the work requirement. Some states use an online portal where you log in and enter your hours or activity. Others require you to submit a form by mail or in person. Some states use a third-party vendor to track work hours and activities.

You will usually need to report your activity monthly or quarterly, depending on your state. Keep records of your work, training, or other activities — pay stubs, letters from your employer or training program, volunteer logs, or school enrollment documents. If your state asks for proof, you will need to show these records. Ask your state Medicaid office what proof they accept and how often you need to report.

Work requirements during public health emergencies

During the COVID-19 pandemic, the federal government suspended work requirements in all states, and most states paused enforcement. As the emergency ended, states began restarting their requirements. Some states restarted them when ready; others phased them back in gradually. A few states chose not to restart them at all.

If your state has restarted work requirements, the rules are usually the same as before the pandemic, though some states made changes. Check your state Medicaid website or call your state office to find out whether requirements are currently in effect in your state and when they restarted if they did.

Frequently Asked Questions

Does Medicaid have federal work requirements?

No. Federal Medicaid law does not require work. The federal government allows states to request permission to add work requirements, and some states have done so, but it is not a federal rule. Your state's rules depend on state law, not federal law.

What if I am disabled but do not receive SSI or SSDI?

If you have a disability but are not receiving SSI or SSDI, you may still be exempt depending on your state's rules. Some states exempt people with serious medical conditions or disabilities even if they are not receiving federal disability benefits. Contact your state Medicaid office to ask whether you may have access to for an exemption based on your specific situation.

Can I lose Medicaid if I miss one month of work?

Most states allow one or two months of non-compliance before they end your coverage, though the exact grace period depends on your state. You will receive notice before your coverage ends, and you can usually restore it by reporting that you have resumed meeting the requirement. Check your state's specific rules.

Do work requirements explore to Medicaid expansion coverage?

Work requirements can explore to Medicaid expansion coverage in states that have them, though the rules vary. Some states explore requirements only to expansion adults; others explore them to other groups as well. Your state Medicaid office can tell you whether the requirement applies to you based on which Medicaid program you are in.

How do I find out my state's specific work requirement rules?

Visit your state health department or Medicaid website and search for "work requirements" or "work activities." You can also call your state Medicaid office directly. They can tell you whether your state has requirements, who they explore to, what counts as meeting them, and how to report your activity.