(Sec. 44141) This section requires, beginning not later than December 31, 2026 (or earlier, at the option of the state), individuals who are eligible for Medicaid as part of the Medicaid expansion population to engage in community service, work, or other activities in order to qualify for Medicaid.
Specifically, the section requires these individuals to, on a monthly basis, (1) work at least 80 hours, (2) complete at least 80 hours of community service, (3) participate in a work program for at least 80 hours, (4) be enrolled at least half-time in an educational program, or (5) engage in any combination thereof for a total of at least 80 hours. Individuals may also qualify if they have a monthly income that is at least as much as the equivalent of minimum wage multiplied by 80 hours.
Individuals who are applying for Medicaid must demonstrate compliance with these requirements for one month or more (as determined by the state) consecutively and immediately prior to filing an application; individuals who are already enrolled in Medicaid must demonstrate compliance for one month or more (as determined by the state), whether or not consecutive, during the period between the individual’s last eligibility determination and the next scheduled eligibility determination.
States must verify an individual’s compliance upon a determination or redetermination of eligibility but may also choose to verify compliance more frequently. States may not waive the new requirements. However, states may choose to provide an exception for individuals experiencing short-term hardships (e.g., hospitalization).
The section excludes certain individuals from these requirements, including those with serious medical conditions or dependent children.
The section provides funds for FY2026 for states and the CMS to implement these requirements.