Medicaid’s new work rule gives a flagged enrollee 30 calendar days to show they comply before a state can deny or end their coverage. The Centers for Medicare & Medicaid Services (CMS) set that step in an interim final rule issued June 1, 2026, and its fact sheet says states must generally put the requirement into effect no later than January 1, 2027.

Who the work rule covers

CMS says the rule applies to non-pregnant adults between 19 and 64 who are not entitled to or enrolled in Medicare and who are covered through the Medicaid adult group or certain section 1115 demonstration programs. The agency counts 43 states and the District of Columbia. U.S. territories are not subject to the law.

To comply, an adult must show 80 hours a month of qualifying activity, be enrolled in school at least half-time, or have monthly income equal to 80 times the federal hourly minimum wage, which CMS puts at $580 a month in 2026. New applicants must meet the requirement for at least one month before the month they apply, and current enrollees for one or more months between renewals.

The enrollee who needs to pay attention is anyone aged 19 to 64 on Medicaid who is not working 80 hours, not in school and not exempt, because the state is the one that checks. If the state cannot confirm compliance from its own records, the next piece of mail is the notice, and the question for that enrollee is what to send back and by when.

A noncompliance notice starts a 30-day window, and the exemptions decide whether an enrollee owes the state anything at all. The SNAP & Medicaid Renewal Organizer covers the new Medicaid work requirement and who is exempt.

Get the Renewal Organizer’s guide to the Medicaid work rule and its exemptions →

How a state flags someone and what the 30 days are for

CMS says states must verify compliance at application and at renewal, and may check more often. A state that cannot verify compliance must “send a notice of noncompliance and provide the individual with 30 calendar days to demonstrate compliance,” the CMS fact sheet says, or to show that an exemption applies. An enrollee who does not respond may be denied or disenrolled, and CMS says a disenrolled person may reapply at any time.

States are supposed to look at their own data before asking anyone for paperwork. A Foley Hoag summary of the rule says states must first try electronic sources such as payroll and claims data. Through the end of 2027, it says, a state may accept a self-attestation made under penalty of perjury for work and most health-related exemptions when reliable data does not exist. From January 1, 2028, states must generally require documents when they are reasonably available.

Why January 1 is not the same date in every state

CMS’s table lists the start as January 1, 2027, “or earlier date chosen by the state.” The state health policy group SHVS reported that Nebraska launched its own work reporting on May 1, ahead of the federal date.

A state that cannot be ready can ask for more time. The Foley Hoag summary says a good-faith exemption cannot run past December 31, 2028, and cannot be renewed. SHVS says CMS will approve such exemptions for up to six months at a time. The Healthcare Financial Management Association (HFMA) reports that CMS projects only about two of roughly ten states that apply would get one, so most enrollees in expansion states should plan for the requirement to begin on or near January 1. The state Medicaid agency’s notice, not a news report, is the date that counts for any one household.

Exemptions that can end a notice

CMS lists the people who are exempt from the work rule:

• Pregnant and postpartum individuals
• People who are disabled or medically frail
• American Indians and Alaska Natives
• Parents and caretakers of children under 14 or of people with disabilities
• Former foster care youth, veterans with a total disability rating, and inmates
• Participants in drug or alcohol treatment
• People meeting TANF work requirements, and SNAP household members not subject to SNAP work requirements

States may also choose short-term hardship exceptions for inpatient or certain other medical care, travel for certain medical care, and counties with an unemployment rate at or above 8 percent or 1.5 times the national rate.

The medically frail exemption takes more than a diagnosis. HFMA reports that frailty requires functional impairment. Michigan’s health department offers an interactive screening guide for Healthy Michigan Plan adults 19 to 64, which says it is not an application or a determination. That guide says people already meeting SNAP work rules are exempt from the Medicaid rule, but that being exempt from SNAP’s rules does not automatically make someone exempt from Medicaid’s.

Answering a Medicaid noncompliance notice inside 30 days

The state Medicaid agency is the one that sends the notice and receives the answer. CMS’s national Medicaid site, Medicaid.gov, carries work requirements information from CMS.

Find the response date on the notice, then pick the response that matches the reason the state gave: pay stubs or a work schedule for the 80 hours, a school enrollment letter, or a statement and records for an exemption. If an exemption applies, such as caring for a child under 14, say which one and attach whatever proof the notice lists. If a reply is mailed, keep a copy and a dated record of when it was sent.

An enrollee who is disenrolled can reapply at any time, according to CMS.

30 calendar days to prove it, or lose Medicaid

The notice an enrollee gets carries the state’s wording, and the exemption that fits is easy to miss under a deadline. The SNAP & Medicaid Renewal Organizer explains the new Medicaid work requirement and who is exempt, and it comes with 51 state packs.

Prepare for a Medicaid noncompliance notice with the Renewal Organizer’s state pack →

This article was produced with AI assistance and edited for accuracy against the sources linked above.