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A new federal requirement means some states are now asking certain Medicaid recipients to document work, job training, education, or community service hours to keep their coverage. Nebraska is one of the first states to enforce it, and reporting this week put the number of people losing coverage there at roughly 200 as the new rule took effect on August 1.
The national deadline for every state to have this in place is January 1, 2027, but states can start earlier, and several already have. If you or someone you help has Medicaid, the safest move is to check your state's specific rules now, before a notice arrives instead of after.
Personalize this article
Name your state Medicaid program
States are rolling this rule out on different timelines, so this keeps the rest of the article specific to you.
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Track offices, issues, promised next steps, and follow-up dates in one running log.
Who the Requirement Applies To, and Who's Exempt
The rule targets what CMS calls a community engagement requirement: certain adults on Medicaid must document a set number of monthly hours in work, job training, education, or community service to keep their coverage. The exact hours and reporting schedule are set at the federal level but applied through each state's own system, and most states require the report on a regular, often monthly, basis rather than as a one-time check.
Most states exempt people who are a certain age or older, people with disabilities, caregivers of young children or a family member with a disability, and several other categories. The exact exemption list is different in every state, so check your own state's list rather than assuming you do or don't qualify. States that have tried similar work requirements before have seen paperwork and reporting problems, not actual ineligibility, cause a large share of terminations, which is exactly why confirming your exemption status in writing matters even if you're confident you already qualify.
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If a Notice Says Your Coverage Is Ending
A termination notice has to state the reason, the rule it's based on, and your appeal rights. You generally have the right to request a Medicaid fair hearing within the deadline printed on that notice, often no more than 90 days from the date it was mailed, though the exact window is on your specific letter.
In many states, requesting a hearing quickly, often within about 10 days of the notice, keeps your coverage active while the appeal is decided. That window is short and easy to miss, so read the notice the day it arrives rather than setting it aside.
Choose your next move
Choose the path that matches your notice
Pick the option that fits what's actually happening with your coverage right now.
Gather the proof your state requires (age, disability, caregiving, or another listed category) and submit it before the deadline.
Interactive toolPrepare specific questions before you callTurn your I think I qualify for an exemption into a short list of questions before you call your state office or legal aid.Show the toolHide the tool
Keep legal aid and paperwork meetings focused on deadlines, documents, and next actions.
Get Help If You Need It
Your state's legal aid organization or a local benefits counselor can often help you gather documentation or represent you at a hearing, sometimes at no cost if your income qualifies. Don't wait until the hearing date to ask; most of the useful help happens in the days before it, when someone can look at your specific notice and tell you exactly which form or proof is missing. If you're caring for a spouse or parent who's affected by this and can't easily make calls themselves, ask whether your state allows you to act as an authorized representative on their Medicaid case. That one piece of paperwork can save you from being turned away when you call on their behalf.
If you already know you'll need that meeting, Prepare for a Legal Aid or Benefits Appeal Meeting walks through how to get the most out of it. If Medicare is also part of your coverage, How Dual-Eligible Medicare and Medicaid Works explains how the two programs fit together.
TimelineWork it in order once a notice arrivesCheck off each step as you complete it.Show the timelineHide the timeline
Find the reason, the rule cited, and the exact appeal deadline in your state's letter.
Send exemption documents or a corrected hours report based on your I think I qualify for an exemption.
Request a fair hearing in writing and ask specifically about continued coverage while it's pending.
Get written confirmation that your hearing request and any continued coverage were received.
Save your plan
Save what you found and decided here so you can follow through before a deadline passes.
Common questions
What is the Medicaid community engagement requirement?
It's a federal rule that requires certain adults on Medicaid to document a set number of monthly hours in work, job training, education, or community service to keep their coverage. States must have it in place by January 1, 2027, and several states, including Nebraska, started enforcing it earlier.
Am I exempt from the Medicaid work requirement?
Most states exempt people who are a certain age or older, people with disabilities, caregivers, and several other categories, but the exact list is different in every state. Check your state Medicaid agency's website or call directly to confirm your status instead of assuming either way.
What should I do if I get a notice that my Medicaid coverage is ending?
Read the notice the day it arrives. It should list the reason, the rule cited, and the deadline to appeal, which is commonly no more than 90 days from the mail date. In many states, requesting a hearing within about 10 days keeps your coverage active while the appeal is decided, so don't wait to respond.
Can I get help preparing for a Medicaid appeal?
Yes. Your state's legal aid organization or a local benefits counselor can often help you gather documentation or represent you at a hearing, sometimes at no cost if your income qualifies. Reach out well before your hearing date rather than the week of it.
