New Medicaid rules will cut off coverage for people who cannot prove they meet new status and work tests. For millions of low-income adults, that could mean losing doctor visits, prescriptions, and hospital care that their budget simply cannot absorb.
Medicaid eligibility rules and legal status
At its core, Medicaid has always had some non-financial rules. To qualify, people generally have to live in the state where they are applying and either be United States citizens or fall into a “qualified non-citizen” category such as lawful permanent residents.
Once a state decides someone is eligible, coverage usually starts on the day they apply or on the first day of that month. People who cannot document an acceptable status are not eligible for full Medicaid in the first place (medicaid.gov).
Medicaid work requirements in 2025 federal policy
What is new is the federal push to tie Medicaid to a minimum number of hours in work or related activities? In the 2025 budget reconciliation law, Congress added a nationwide “community engagement” requirement for many adults who gained coverage through the Affordable Care Act expansion, which reaches people with incomes up to about 138% of the poverty level, as well as similar waiver groups (cbpp.org).
80 hours per month requirement and qualifying activities
Under the new rules, affected applicants and enrollees will have to show at least eighty hours each month in qualifying activities. Paid work counts, but so do formal half time education, job training programs, community service, or a mix of those.
Adults who cannot prove either compliance or an exemption will be denied coverage at application or cut off at renewal (cbpp.org).
Who is affected and Medicaid exemptions
The requirement targets most adults in the expansion population, generally those between nineteen and sixty four. Children, people already in mandatory categories, many people with disabilities, pregnant people, and those on Medicare are excluded.
States may also recognize “short-term hardship” situations, such as a serious illness or a declared disaster, and they are supposed to use payroll and other data first instead of making people chase extra paperwork. In theory, that should lighten the load, although advocates worry practice will look very different (medicaid.gov).
Enrollment impact and coverage loss estimates
Researchers note that more than twenty million adults are enrolled through the expansion pathway, so even a small percentage losing coverage is a big number. One Congressional Budget Office estimate cited by UC Berkeley analysts suggests that work documentation rules in the federal package could cut enrollment by roughly five million adults (cbpp.org).
What Medicaid enrollees should do next
So what should people on Medicaid do now? For the most part, experts urge enrollees to keep their contact information updated, open every letter from the state health agency, and ask questions early if a notice mentions community engagement or immigration status. If you are a green card holder working part time and wondering whether your evening classes count toward those eighty hours, you are far from alone.
Community health centers, legal aid offices, and navigator programs can help people understand which category they fall into and what proof they will need.
The official statement was published on Medicaid.gov.
