WASHINGTON — States across the United States have begun notifying Medicaid beneficiaries about upcoming work requirements that will become a condition of eligibility for certain adults under a new federal mandate, state officials and federal regulators said this week.
The notices follow the release of an interim final rule by the Centers for Medicare & Medicaid Services (CMS) on June 1 outlining how states must implement the requirements established under federal law. The rule requires certain Medicaid enrollees ages 19 to 64 to complete at least 80 hours per month of work, education, job training or community service, or qualify for an exemption, beginning no later than Jan. 1, 2027.
CMS said states must provide clear information to beneficiaries about eligibility requirements, exemptions, reporting obligations and renewal procedures. The agency's guidance places particular emphasis on outreach and communication as states prepare eligibility systems and administrative processes ahead of the federal deadline.
Nebraska, which implemented a state-level Medicaid work requirement program earlier than most states, has already begun contacting affected beneficiaries during eligibility reviews and renewals, according to state health officials. Other states are preparing informational mailings, online notices and outreach campaigns to explain the forthcoming federal standards.
“The Working Families Tax Cut legislation made historic changes to the Medicaid program, and CMS is working closely with states to put those changes into action,” CMS Administrator Mehmet Oz said in a statement accompanying the new guidance.
The requirements apply primarily to certain adults covered through Medicaid expansion programs. Exemptions are available for several categories of beneficiaries, including pregnant and postpartum individuals, people deemed medically frail, many caregivers, people with disabilities, and certain participants already meeting work requirements through other assistance programs, according to CMS.
State officials have said implementation will require extensive updates to eligibility systems, verification procedures and communications infrastructure. CMS announced that states will receive federal grants and technical assistance to support the transition.
The rollout has also drawn criticism from some Democratic governors, healthcare organizations and congressional Democrats. A coalition of governors recently urged the federal government to slow implementation, arguing that states face a compressed timeline to update systems and notify beneficiaries. Representative Frank Pallone of New Jersey said the requirements could result in eligible people losing coverage because of administrative burdens rather than a lack of employment.
Supporters of the policy argue that the requirements encourage workforce participation and help preserve Medicaid resources for vulnerable populations. CMS officials have said the rules are intended to promote employment, education and self-sufficiency while maintaining exemptions for individuals with significant health or caregiving needs.
As of June, states were continuing to update enrollment systems and prepare beneficiary outreach campaigns. Federal officials said all affected states must have compliant procedures in place by the start of 2027, while notices and educational materials are expected to expand throughout the remainder of this year and into next year.
