Medicaid's 80-Hour Rule: Who Must Show Work by January 2027

Millions of Medicaid beneficiaries will be required to document 80 hours per month of work or other qualifying activity beginning 1 January 2027 under the Republican healthcare reform law.

The law is H.R.1 of the 119th Congress (2025-2026), also known as the One Big Beautiful Bill Act. President Donald Trump signed it on 4 July 2025. It is designated as Public Law 119-21, the FY2025 budget reconciliation law, according to the Congressional Research Service. The measure cut roughly $1 trillion in federal spending from the healthcare industry, The Guardian.

Medicaid is the joint federal-state health insurance program. More than 82 million people rely on Medicaid for health insurance, about 23% of the American public. Medicaid spent $937 billion in 2024, according to the Centers for Medicare and Medicaid Services, The Guardian.

The new condition is termed a Medicaid community engagement requirement. It was enacted under Public Law 119-21. It applies to ACA Medicaid expansion enrollees (people covered after states broadened Medicaid under the Affordable Care Act) and certain Medicaid Section 1115 waiver enrollees (people in state pilot programs approved by Washington) in 44 states, according to KFF tracking, KFF.

Compliance is defined as working, completing community service, or participating in a work program for not less than 80 hours. Think of it as a monthly timesheet. The 80-hour threshold can be met through a combination of qualifying activities. Attending school counts toward the requirement starting 1 January 2027. Earning income of at least $580 per month also satisfies the rules.

States must generally implement the requirement no later than January 1, 2027. States may choose to implement earlier. CMS has launched a nationwide framework to implement the work requirements and has issued interim guidance through an interim final rule with comment period, CMS.

For applicants, the process looks back. Individuals applying for Medicaid must demonstrate compliance for one to three consecutive months, as determined by the state. Before 2028, members can self-attest (report on their own) to having met the requirements, according to a CMS official, Reuters.

State agencies are now translating that framework into eligibility operations. Wisconsin officials state the new federal requirement will affect some members enrolled in BadgerCare Plus in 2027.

The broader context here is implementation rather than statute. The law sets the date and the hours threshold. The near-term variables are state decisions on the one-to-three-month verification window, which populations within expansion and waiver groups are subject to exemptions, how early-implementer states sequence systems changes, and what verification infrastructure replaces self-attestation after 2027. For those tracking coverage effects, those administrative choices will shape how the $1 trillion reduction interacts with enrollment continuity in the 44 affected states.