Medicaid Work Requirements 2026: Who Loses Coverage in December — The Complete Checklist

# Medicaid Work Requirements 2026: Who Loses Coverage in December — The Complete Checklist

> **Quick answer:** Federal Medicaid work requirements require ACA expansion enrollees to document 80 hours per month of work, volunteering, school, or job training — or lose coverage. Iowa enforces December 1, 2026. All remaining expansion states hit the deadline January 1, 2027. Between 3 and 11.8 million people will lose coverage. The unsettling finding: 19–37% of those who lose coverage are already working but cannot prove it. This checklist tells you exactly where you stand.

Medicaid work requirements 2026 are the largest change to the Medicaid program in a generation — and the deadline clock is running. Nebraska enforced first on May 1. Iowa enforces December 1. Every other expansion state follows January 1, 2027. Up to 11.8 million Americans are in the crosshairs, including millions who are working, in school, or caregiving but may not realize the paperwork burden is about to erase their coverage.

> **This article is for informational purposes only and does not replace professional medical or legal advice. If you receive a notice about your Medicaid coverage, contact your state Medicaid agency or a certified enrollment counselor immediately.**

## What the Law Actually Requires — The 80-Hour Rule Explained

The Medicaid work requirements come from H.R. 1, the "One Big Beautiful Bill" reconciliation law signed in 2025. It targets adults in the ACA Medicaid expansion population — generally, people ages 19–64 with incomes at or below 138% of the federal poverty level who gained coverage under the Affordable Care Act.