Maryland Medicaid members between 19 and 64 will have to show work, school or volunteer activity to keep coverage starting Jan. 1, 2027, and some will renew twice a year instead of once. The Maryland Department of Health says people 65 or older are exempt, as are people who have Medicare Part A or Part B. Older adults and people with disabilities are the groups most likely to be asking whether the new rules reach them.
Who the rules cover and who they skip
The state’s work requirements page says the changes apply to up to 320,000 Maryland Medicaid members. About 1.5 million Marylanders are on Medicaid, so most are not affected. The federal law behind the change is H.R. 1, passed in 2025.
The Maryland Health Connection Medicaid Check-In page, last modified Oct. 16, says the work rules apply to adults 19 to 64 with income up to $21,000 a year for one person or $44,000 for a family of four. The page lists general exemptions for anyone under 19, anyone 65 or older, anyone with Medicare Part A or Part B, and anyone who left jail or prison within the past 90 days.
For example, a 66-year-old on Medicaid and a 62-year-old who already has Medicare because of a disability are both outside the work rules. A 58-year-old with Medicaid and no Medicare is the person the rules are written for, unless another exemption fits.
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What counts as meeting the rule
A member who is not exempt must meet one of three tests, according to the state: earn at least $580 a month from a job, attend school at least half-time, or complete 80 hours a month of paid work, school, job training or volunteering. The state says the hours can be combined across activities. The state also lists short-term hardships as a reason for relief, such as a recent hospital, nursing home or care-center stay, or travel out of the area for medical care.
The state says Maryland Health Connection will first check data it already holds. If it needs more proof, it will send a letter or email explaining what to submit. Notices went to members who must meet the rules in September, so anyone who is 19 to 64, has no Medicare and has not opened mail from the state needs to look for one now.
Members also have to show they met the requirement at their first renewal in 2027. The Check-In page says they must prove they met it for at least one month.
Health conditions and caregiving
People with disabilities who are 19 to 64 and have no Medicare have their own exemptions. The Check-In page lists health conditions that limit work, including blindness, physical or mental health conditions, substance use disorder or treatment, and complex medical conditions. It also exempts veterans with a disability and people who care for a child under 14 or for a person with a disability.
Other exemptions cover pregnancy and the first 12 months after a birth, American Indian and Alaska Native members, certain former foster youth under 26, and members who already meet SNAP or TANF work rules. The state adds that people in areas with high unemployment or a declared emergency may get an exemption, and that a letter will go out if it applies.
The state asks members to log in to Maryland Health Connection or use its online tool to see whether the rules apply to them. They should keep contact information current, report income or household changes, and read every letter and email. Job training options are listed through the Maryland Benefits Job Training Search Tool.
Six-month renewals and the October immigrant change
The work requirements page says members will get an official notice before any change takes effect. It repeats the advice to keep contact information current in a Maryland Health Connection account, since a notice sent to an old address is the easiest way to miss a deadline. The Maryland Department of Health can be reached at 410-767-6500 or 1-877-463-3464.
The Department of Health says some adults will renew twice a year instead of once. A shorter cycle means twice as many chances to miss a letter. The Check-In page says the work rules and the six-month renewals both begin Jan. 1, 2027.
A separate federal change already took effect on Oct. 1, 2026. The state’s eligibility changes page says some non-citizen adults no longer qualify. The Check-In page lists Cuban and Haitian entrants, COFA migrants and lawful permanent residents among those who still do, and says children and pregnant people are not affected.
For help, Maryland Health Connection’s Consumer Support Center is at 1-855-642-8572, and the HealthChoice Helpline for benefits questions is at 1-800-284-4510. The open question for most Maryland households is simple: is the person on Medicaid under 65 with no Medicare, and if so, which of the three tests will they meet when the first 2027 renewal arrives?
Under 65 on Maryland Medicaid with no Medicare?
A Maryland adult on Medicaid who misses a notice or a renewal date can lose coverage even while exempt or while working enough hours, because the state needs the proof on file by its deadline. The stake is a gap in doctor visits and prescriptions until the case is reopened.
The SNAP & Medicaid Renewal Organizer is a 20-page guide that includes a renewal document checklist, a renewal and reporting calendar and 51 state packs. It also walks through the new Medicaid work requirement and who is exempt, so a household can mark each Maryland date in one place.
Get the Maryland Medicaid renewal document checklist and six-month reporting calendar →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
