Medicaid Work Requirements 2026: Who Loses Coverage — Even If They Work

# Medicaid Work Requirements 2026: Who Loses Coverage — Even If They Work

> **Quick answer:** Federal Medicaid work requirements took effect through the One Big Beautiful Bill Act (signed July 4, 2025), requiring adults ages 19-64 in Medicaid expansion programs to log 80 hours per month of work or qualifying activity. Nebraska launches enforcement May 1, 2026 — the first state in the nation. Between 4.9 and 10.1 million people could lose Medicaid by 2028. The most alarming finding: 19 to 37% of people who already work are projected to lose coverage anyway because they cannot meet the documentation burden. Here is what you need to know and what to do before your next renewal.

> **This article is for informational purposes only and does not constitute legal or medical advice. Consult a qualified attorney or healthcare navigator for guidance specific to your situation.**

Medicaid work requirements 2026 are no longer a policy debate — they are live law, rolling out state by state. If you or someone you know is on Medicaid expansion coverage, the rules you need to follow have already changed, and the paperwork you need to submit could determine whether you keep your health insurance.

## What the Law Actually Requires

The One Big Beautiful Bill Act, signed by President Trump on July 4, 2025, overhauled Medicaid eligibility in the most sweeping reform since the Affordable Care Act. The work requirement provisions target Medicaid expansion adults — the roughly 20 million people covered through the ACA's expanded eligibility rules in 41 states.