Who do the requirements apply to?

Medicaid work requirements do not apply to everyone with Medicaid, and some states are not affected. Whether you need to meet them depends on your state Medicaid program, your Medicaid coverage, and your circumstances.

The work requirements generally apply to certain adults ages 19 through 64 who have Medicaid. Your type of Medicaid coverage and other circumstances can affect whether you need to meet them.

The requirements may apply if you:

  • Are between 19 and 64 years old,
  • Are not pregnant, and
  • Do not have Medicare coverage.

But these are not the only factors to tell whether you need to meet the requirements. A few states are not affected by the work requirements. Your state decides which Medicaid rules apply to you.

How can I find out if they apply to me?

Visit your state’s Medicaid program website to find current information about the requirements in your state.

Find your state Medicaid agency

State Medicaid programs are required to tell you about work requirements by mail or electronically, and may also contact you by:

  • Phone calls 
  • Text messages 
  • State Medicaid websites 
  • Other electronic communications 
  • Other outreach formats

Who does not have to meet work requirements?

Medicaid work requirements generally do not apply if you are:

  • Age 18 or younger
  • Age 65 or older 
  • Pregnant or eligible for state postpartum coverage
  • Enrolled in Medicare

Check with your state Medicaid office to find out whether work requirements apply to you.

Being exempt from work requirements

Some people with Medicaid may qualify as exempt from work requirements. This means they do not need to meet work requirements in order to enroll in or keep their Medicaid coverage. Exemptions may be based on medical diagnosis, disability status, caregiving responsibilities, or other factors.

You may be exempt if you are:

Some states may offer temporary exemptions called “hardship exceptions.”

Check with your state Medicaid office about your state’s rules and exemptions.

What “medically frail” means

Having a medical diagnosis does not automatically exempt you from Medicaid work requirements. To qualify as “medically frail,” your treating healthcare provider must document that your physical or mental health condition significantly limits your ability to work, volunteer, or attend school for 80 hours a month.

How do I get an exemption?

State Medicaid programs have their own rules and instructions to ask for an exemption. This means they may ask for information or documents to show that you qualify for the exemption.

For example, you may need information or documents about:

  • Your health or disability
  • Your caregiving responsibilities
  • Your work or school status
  • Your Medicaid coverage

Some documents may need to be provided and signed by your healthcare provider. Your state Medicaid office can tell you what you need to provide and how to submit it. Check with your state Medicaid office about what they need for exemptions.

What if my situation changes?

You should contact your state Medicaid office if your circumstances change. A change may affect whether the requirements apply to you or whether you qualify for an exemption.

For example, if you:

  • Start or stop working
  • Start or leave school
  • Become a caregiver
  • Have a change in your health
  • Become pregnant
  • Get or lose other health coverage

Examples: Who do the requirements apply to?

The examples below show how different situations can affect whether someone needs to meet the Medicaid work requirements, whether their activities count, and whether they may qualify for an exemption.

woman working at medical reception desk

Elena: The requirements apply, and she meets them through work

Elena is 42 and lives in Lexington, Kentucky. She has Medicaid and works part-time as a receptionist at a local dental clinic.

  • Elena works about 22 hours each week, or about 88 to 92 hours each month. If the Medicaid work requirements apply to Elena, her paid work hours are enough to meet the 80-hour monthly requirement.
  • Elena reports her work hours according to her state’s process and keeps records of her employment and hours worked.

What this example shows: If the requirements apply to you, paid work may count toward the required hours. If you meet the required number of hours through work, you may not need to complete other qualifying activities.

Marcus: The requirements apply, but he does not meet them

Marcus is 34 and lives in Lincoln, Nebraska. He has Medicaid and works part-time as a delivery driver. He also helps his uncle with a flooring business when work is available.

  • In April, Marcus works a combined 72 hours between his two jobs. If the 80-hour requirement applies to him, he is 8 hours short.
  • Marcus also spends 10 hours searching and applying for a full-time job. However, job-search hours do not count toward the requirement under the rules in this example.
  • Marcus reports his 72 hours and receives information from his state Medicaid agency about what he can do next.
man installing flooring

What this example shows: Working does not automatically mean you have met the requirement. You need to know which activities count and how many hours you need to complete.

smiling nonbinary person of color

Jordan: The requirements apply, and they meet them through other activities

Jordan is 28 and lives in Wise, Virginia. Jordan has Medicaid and is enrolled in a certified nursing assistant program after losing a retail job.

  • Jordan spends about 15 hours each week in classes and clinical training, or about 60 hours each month. Jordan also volunteers at a local senior center for about 5 hours each week, or about 20 hours each month. Together, these activities total about 80 hours each month.
  • Jordan keeps records of the class schedule and volunteer hours and reports qualifying activities according to the state’s process.

What this example shows: If the requirements apply to you, you may be able to meet them through a combination of qualifying activities, such as education and community service.

Sarah: The requirements may not apply because she qualifies for an exemption

Sarah is 51 and lives in Cincinnati, Ohio. She has Medicaid and has been diagnosed with multiple sclerosis and depression. Her symptoms can flare unexpectedly and make it difficult for her to work, volunteer, or attend school for extended periods.

  • Sarah asks her state Medicaid agency whether she may qualify for an exemption. Her healthcare provider provides documentation about how her health conditions affect her ability to complete the required activities.
  • If Sarah meets her state’s criteria for exemption, she does not have to meet the 80-hour requirement while the exemption applies. Her state may have specific rules about how the exemption is documented, reported, or renewed.

What this example shows: Some people who cannot meet the requirements because of significant health needs may qualify for an exemption. Having a medical condition does not automatically mean you qualify, so check your state’s rules.

What should I know next?

If the requirements apply to you

If the requirements apply to you and you do not qualify for an exemption, learn which activities may count and how to report them.

Learn more
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If you cannot meet the requirements

If the requirements apply to you and you cannot meet them, you could lose your Medicaid coverage. Learn about your options.

Read more