Starting in December 2026, millions of Americans enrolled in Medicaid will face a serious new requirement: prove you’re working 80 hours a month—or risk losing your health insurance. This major change is buried in the newly passed One Big Beautiful Bill Act, and while it’s being marketed as a way to boost employment, health experts and advocates warn it could leave millions without coverage, especially those with low-wage or unstable jobs.
Here’s exactly what the new rule means, who’s affected, and what you need to do to stay insured.
The New Medicaid Work Rule Explained
Under the new federal law, all able-bodied adults between ages 19 and 64 who are enrolled in Medicaid under the Affordable Care Act’s expansion must prove they’re engaged in 80 hours per month of one or more of the following:
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Paid work (full-time or part-time)
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Job training
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Approved education programs
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Community service or volunteering
Failing to meet or properly document these hours could mean losing your health coverage—sometimes with no warning.
Who Must Comply—and Who Is Exempt
If you’re on Medicaid and don’t fit into one of these exempt groups, you’ll be required to meet the 80-hour threshold:
Exemptions include:
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Pregnant individuals
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Primary caregivers for children under 14
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People with disabilities or those deemed “medically frail”
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Seniors aged 65+
But here’s the tricky part: you must submit proof that you qualify for one of these exemptions. A simple paperwork error or missing document could still cost you your coverage—even if you’re clearly eligible to be excluded.
What Happens If You Don’t Meet the Requirement?
This isn’t just a warning—it’s a hard cutoff. If you don’t meet the 80-hour rule or fail to provide the right paperwork, your Medicaid benefits will be terminated. In some states, the government may also review past months and deny renewal if you can’t prove past compliance.
In states that previously tried similar work requirements—like Arkansas and Georgia—thousands of people lost their health insurance because they didn’t submit the right documentation, even though many were actually working.
How Many People Could Lose Coverage?
According to the Congressional Budget Office and Kaiser Family Foundation:
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Around 18.5 million adults will fall under this new work rule.
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Up to 4.8 million people are projected to lose Medicaid by 2034 due to non-compliance.
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The policy could result in 12 million total uninsured Americans once fully implemented.
This will hit low-income families, rural residents, and people with inconsistent work schedules the hardest. Many of these individuals rely on Medicaid not just for doctor visits, but for life-saving medications and emergency care.
Key Dates You Need to Know
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December 31, 2025: The federal government will issue final instructions to states.
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By December 31, 2026: All states must enforce the new rules—some may begin earlier.
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Through 2028: States can request temporary delays if systems aren’t ready, but no guarantee those delays will be granted.
If you’re a Medicaid enrollee or applying in 2026, you’ll need to start tracking your hours and paperwork carefully—or you could lose access to healthcare when you need it most.
Final Thoughts
While the “Big Beautiful Bill” offers permanent tax cuts for the wealthy, it demands more red tape, stricter rules, and more risk for low-income Americans—especially those who depend on Medicaid. Whether you’re working part-time, caring for kids, or dealing with a disability, the burden now falls on you to prove your eligibility.
For millions, it’s not just about work. It’s about whether they’ll be able to see a doctor, fill a prescription, or pay for emergency surgery.
