Medicaid work requirements set to affect millions of Americans

New federal work and reporting requirements for Medicaid recipients are set to take effect on January 1, 2027, potentially putting approximately 10 million Americans at risk of losing healthcare coverage. The changes stem from federal legislation signed by President Donald Trump in July 2025.

Under the new rules, most eligible adults aged 19 to 64 must demonstrate qualifying activity to maintain coverage. This can be achieved through 80 hours of work, community service, or participation in qualifying work programs per month. Alternatively, recipients may meet the requirement by meeting an income standard of at least $580 per month. Enrollment in a half-time educational program also serves as a qualifying route. Certain groups, such as qualifying caregivers, are exempt from these requirements but must undergo eligibility reviews every six months.

In response to the upcoming changes, a new $2 million independent nonprofit campaign titled ‘Keep Your Care’ has launched to educate states and recipients. In North Carolina, officials are urging residents to update contact information and maintain eligibility records to avoid losing access to medical visits and prescriptions. Additionally, separate restrictions regarding noncitizen eligibility for full Medicaid coverage are scheduled to begin on October 1, 2026.