For adults 19 to 64 on Medicaid · on your device, answers never sent

Keep your Medicaid through the work rule.

From January 2027 (earlier in a few states), most adults on Medicaid expansion must show 80 hours a month of work, school, volunteering or a work program, or $580 of income, unless the rule does not apply to them. Most people who lose coverage over rules like this were working or exempt; they lost it on paperwork. Four tools below. Your answers stay in this browser.

Helping others keep theirs? Print a one-page sheet for any state, with a QR code to this page.

What your state has published, one page per state with every source: every state.

First: can your state reach you?

When Arkansas ran a work rule in 2018, about 18,000 adults lost Medicaid in four months. Most of them never sent the state a single report, and more than 70% of people surveyed were not sure whether the rule was even in effect. Health Affairs, 2020

Under the federal rule, your state has to send a notice before the rule starts for you: by mail (or electronically, if you chose that) and at least one other way, such as a text, a call or your online account. CMS rule, 42 CFR 435.561(d) That notice only helps you if it gets to you.

Give your Medicaid office your current mailing address and the cell number you actually answer. Do it now, and again within days of any move.
If they offer text or email alerts, say yes.
Open every letter from Medicaid the day it comes. The dates in it are short.
If you have no steady address, ask the office what address you can use, such as a shelter, a clinic or a friend.

Pick your state in step 1 and its own Medicaid page shows here.

1. Does the rule apply to you?

Tap an answer. Easy questions first, the way states are told to check.

Your state

Proof your state has published

A checklist for your state, read from the same rules file as step 1. Where your state has not said, it says "not published": ask your Medicaid office, and keep copies of what you send. Your state decides; this only explains.

Pick your state in step 1 and its checklist shows here.

Hard to read small print? Print a large-print packet: your state's rules and this checklist in big type, one state per page, with every source.

2. Your monthly log

Write down each month as it ends. Your state may ask about one to three recent months at renewal. Volunteering counts only through a public agency or nonprofit program that tracks your dates and hours; ask them for the contact name. Your state must check the records it already has before it asks you for papers; if it does ask, a signed hours note and your pay stubs are ready.

3. Never miss a renewal

Expansion adults renew every six months. Pick your next renewal month (it is on your last notice). You get a calendar file with a reminder a month before each of your next four renewals, and a monthly nudge to fill in your log. The file is made here and saved by you; it is never sent.

Next renewal month

4. A letter came. Now what?

If your state cannot confirm you meet the rule or are exempt, it must give you at least 30 days to show it. The date on your letter wins; use it.

Date printed on the letter

Read which month the letter asks about, and what it lists as proof.
If you are exempt, say which reason by name (for example, family caregiver of a person with a disability).
Send what it asks for the way it asks, and keep a copy and a confirmation number.
Call first if anything is unclear. Practice the call and log it.
If coverage ends, you can reapply, and you can ask for a fair hearing within the time your notice gives.
If a health condition is why you cannot meet the hours, build a dated record now: Build your record.

5. Coverage ended. What now?

Losing Medicaid over the work rule also closes the usual backup: you cannot get the Marketplace premium subsidy for that reason (Pub. L. 119-21 sec. 71119). So move fast, in this order. Enter the dates on your letter to see each last day.

Ask for a fair hearing now. Your notice says how and by when. If you ask before the date the change takes effect, your coverage usually continues until the hearing decides (42 CFR 431, subpart E). See your state's deadline and print a request letter.
Reapply as soon as you meet the rule or are exempt. Your state looks at the month or months before you apply; pick your state in step 1 to see how many. Bring your log from step 2.
Do not wait to reapply. From 2027, coverage for expansion adults reaches back only one month before the month you apply (H.R.1, via Justice in Aging).
Ask about hardship. A hospital stay, travel for care, or living in a disaster area or high-unemployment county can excuse a month. Ask the state which ones it uses.
Care in the meantime. Community health centers see people with or without insurance and charge on a sliding scale by income: find one near you. Any emergency room must screen and stabilize you in an emergency. A hospital bill from the gap: see what you are owed.
Keeping the home warm and safe. Public programs can help with heating bills, a drafty home and safety repairs, for owners and renters: see which ones and how to ask.
60 or older, or helping a parent? Medicare cost help, food help and senior meals are often missed: see what may fit and where to ask.
Caring for family. Some programs pay a family member to give care, and some laws let you take time off work to give it and keep your job: can I be paid to care? and keep your job while caring.
Legal help. Legal aid offices help with Medicaid hearings, usually at no charge to people with low income. Call 211 and ask for legal aid near you.

On a shared or library computer?

Everything you enter here is saved in this browser, so it is there when you come back. On a computer or phone other people use, clear it when you are done: your answers, your log, your calls, your dated record and your state.

Ask your own AI to walk you through it

Your AI assistant (ChatGPT, Claude, Gemini or another) can read the same rules this page uses and explain them in your words or your language. Copy this, paste it into your assistant, then tell it your situation there. medfrail never sees the conversation.

Worried that using Medicaid, SNAP or WIC could hurt an immigration case? The “public charge” rule changed on September 18, 2026. What the rule says, and where to get legal help.