About 700,000 Illinois adults who joined Medicaid through the Affordable Care Act expansion will have to show 80 hours a month of work, volunteering or school to keep their coverage. The Illinois Department of Healthcare and Family Services, known as HFS, began mailing notices to the group in early September. Current enrollees could start losing coverage in 2027, when their regularly scheduled renewal comes up.
Who is in the group of 700,000
HFS calls them ACA Adults. They are ages 19 through 64, earn less than 138 percent of the federal poverty level, have no related child under 18 at home and do not have Medicare Part A or B. Parents and caretaker relatives who live with a child are generally outside the group.
Officials estimate about half of the people being notified live in Cook County, WBEZ reported. Roughly 3 million Illinoisans, about 1 in 4, are on Medicaid in all, so the work rule reaches a large share of the program but not all of it.
HFS says on its federal changes page that no one will be required to act until they receive direct notice from the state. The September 1 letter tells current enrollees to check for an exemption, keep their address, phone and email current, and set up a Manage My Case account at abe.illinois.gov.
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The agency put the group’s size at “about 700,000 Illinoisans” in a July 14 webinar for providers. The same slides, marked as a draft for discussion, carry a harder number. HFS’s internal estimates there project that between 165,000 and 330,000 people could lose coverage.
What counts as 80 hours
The test is at least 80 hours a month of work, community service or a work program, or monthly income of at least $580, which is the $7.25 federal minimum wage times 80. Time in school or training at least half time also counts. Activities can be added together, but people in the same household cannot pool their hours.
Seasonal workers can qualify with average monthly income of at least $580 over the last six months. Enrollees can mail work-requirement forms to the Central Scanning Unit, P.O. Box 19138, Springfield, IL 62794, or fax them to 1-844-736-3563, the notice says. A screener and the work-requirement form are expected in late 2026, and HFS says it will announce when they are ready.
Some enrollees do not have to prove anything. HFS’s toolkit lists pregnant and postpartum people, medically frail people and American Indians and Alaska Natives among those excluded. The September notice adds that someone in a household with both SNAP and Medicaid may be exempt if they meet SNAP work rules. Exempt people still have to complete the new six-month renewals.
When current enrollees could lose coverage in 2027
New applicants come first. Starting January 1, 2027, adults in this group who apply must show they met the rule in the month before applying. HFS says Illinois picked the shortest review period federal law allows.
The timing follows a federal notice rule. HFS must warn affected customers at least four months before the requirement applies to them, which is why the first letters went out in early September 2026.
Current enrollees get more time. HFS’s toolkit and notice put their change at the regularly scheduled renewal during 2027. An HFS spokesperson told WBEZ that the earliest they would lose coverage is April 1, 2027. Losses could keep coming on a rolling basis as each person reaches a renewal, because HFS will check the rule at the federally required six-month intervals.
At a renewal, HFS looks at one month of activity since the last decision. When its data systems cannot confirm an activity, the agency will accept a person’s own statement, made under penalty of perjury. If HFS needs more information, the enrollee has 30 days to respond, and coverage ends at the close of the current eligibility period for anyone who is neither exempt nor meeting the rule.
Paperwork is where many people could slip. Kathy Chan, director of policy at Cook County Health, told WBEZ that about 10 to 15 percent of Medicaid enrollees already lose coverage each month because of paperwork problems, not because they are ineligible. She called the work rule “a huge step backward.”
If coverage does end
The HFS notice says people who lose Medicaid may be able to get a plan through Get Covered Illinois, but without advanced premium subsidies. Anyone unsure whether the ACA Adult description fits can call ABE Customer Service at 1-800-843-6154.
A separate change took effect October 1. About 8,500 Illinois residents with legal status who are not citizens, such as refugees and trafficking survivors, lost eligibility under the federal law, WBEZ reported. That group is not part of the 700,000 work-rule count.
HFS says the first renewal in 2027 is where affected enrollees must show compliance. The open question for each household is when that renewal lands, and the agency’s letter and ABE Customer Service are where that date comes from.
Not sure if Illinois’ 80-hour rule covers a household?
The first renewal in 2027 is where Illinois checks the work rule, and a missed 30-day response or an unreported change is how coverage gets dropped on paperwork alone. For the 700,000 adults in the ACA group, knowing the dates matters as much as logging the hours.
The SNAP & Medicaid Renewal Organizer walks through the new Medicaid work requirement and who is exempt, and it comes with a renewal and reporting calendar so a notice date does not slip by.
It includes 51 state packs, Illinois among them, and a renewal document checklist for pulling the paperwork together before a renewal comes due.
Get the Illinois work-rule pack and renewal calendar →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
