Medicaid's New Work Rule Takes Effect in 2027—Who Will Be Impacted?

A new Medicaid work requirement will begin on 1 January 2027 for beneficiaries in expansion states. Adults aged 19 to 64 must work, volunteer, or attend school for at least 80 hours a month to stay enrolled. Wisconsin expects around 63,000 residents to be affected by the change. The rule stems from a tax-cut bill signed by President Donald Trump in 2017. It mandates that states verify compliance using existing data and grant a 30-day grace period for violations. Eligibility will be checked at least twice a year to ensure ongoing adherence.

Some states, including Nebraska and Arkansas, are rolling out the requirement early. Exemptions apply to pregnant women, caregivers, disabled veterans, foster youth, and those with substance use disorders. The rule also defines 'medical frailty' exemptions more strictly than many expected.

On 1 June, the Centers for Medicare and Medicaid Services (CMS) published guidelines outlining verification standards and exemption criteria. Critics argue the rule reduces state flexibility and limits protections for vulnerable groups. Wisconsin plans to launch the requirement on the official date to ensure a smooth transition. The policy will reshape Medicaid access for thousands of adults in expansion states. Compliance checks and exemptions will determine who remains eligible under the new system.