Medicaid Work Requirements in 2026: What to Do If You Lose Coverage

Who Has to Meet the Requirement — and Who's Exempt

The requirement applies to most adults ages 19–64 in the Medicaid expansion group who don't have dependents. But federal law carves out exemptions, and your state may add more. You're typically exempt if any of these apply:

Here's the part that trips people up: an exemption isn't automatic. If your state doesn't already have proof on file, you may need to submit it yourself — and resubmit it at each review. Assume nothing is on record until you've confirmed it.

Why Most People Will Lose Coverage Over Paperwork — Not Work

Researchers estimate roughly 5 to 10 million people could lose Medicaid by 2028. But most of those losses aren't expected to come from people who fail to work — they're expected to come from reporting confusion: a renewal letter mailed to an old address, a verification form that never gets returned, an exemption the state didn't know about. And with redeterminations happening every six months for the expansion group instead of once a year, there are twice as many chances for something to slip through. The requirement isn't just to work 80 hours a month — it's to prove it, on your state's schedule, in your state's format.

How to Protect Your Coverage Right Now

1. Gather your documentation now. Pay stubs, school enrollment records, training program confirmations, volunteer logs — start a folder before your state asks.
2. Update your address with your state Medicaid agency. A huge share of disenrollments start with mail that never arrives. Do this even if you think it's current.
3. Respond to every mailing. Renewal packets and verification requests have hard deadlines. Open everything from your state agency, even if it looks routine.
4. Document any exemption. If you're pregnant, disabled, caregiving, or medically frail, submit proof and keep copies — don't assume the state already knows.
5. Report your hours on time, every time. Learn your state's reporting system and deadlines before the first check, not after.

The Coverage Gap: Why You May Not Get a Marketplace Subsidy

This is the catch almost nobody sees coming. Normally, someone who loses Medicaid can move to an ACA marketplace plan with a premium tax credit that makes it affordable. But under current law, people who lose Medicaid for failing to meet work requirements are generally not eligible for marketplace premium tax credits. That leaves a genuine coverage gap: too little income to afford a full-price plan, but disqualified from the subsidy that would have made one affordable. If you lose Medicaid this way, your realistic options are an employer plan (losing Medicaid triggers a special enrollment window at work), a spouse's plan, or a full-price marketplace plan if you can manage the premium.

If You're Wrongly Disenrolled: Appeal — For Free

If you meet the requirements or qualify for an exemption and still lose coverage, you have the right to request a fair hearing through your state Medicaid agency. Deadlines are short — often measured in weeks — so file quickly, even if you're still gathering documents. You don't have to do it alone: legal aid organizations help with Medicaid appeals at no cost, and wrongful disenrollments are frequently overturned once the missing paperwork is supplied. While you fight it, federally qualified health centers (FQHCs) can provide reduced-cost primary care on a sliding-fee scale — though they don't cover hospitalization, so an appeal or new coverage should stay the priority.