Community Engagement Requirement

The new federal law changed the rules for how some Medicaid members qualify for and keep their Medicaid coverage. This new rule says that certain members must now show they are working or active in their community.

Starting January 1, 2027, if this rule applies you, you must show that you are doing one or a combination of these things for 80 hours each month in order to keep your Medicaid:

  • Working a job.
  • Training for a job.
  • Going to school (at least half-time).
  • Volunteering (community service).
  • Earning at least $580 a month.
  • Showing why you cannot work or volunteer.

You may need to provide proof of these activities every 6 months during your review.

Who is affected?

This new rule applies to adults in the Adult Expansion and Targeted Adult Medicaid (TAM) programs. This includes members, age 19–64, unless they meet specific exclusion criteria.

Who is excluded from this requirement?

Adults who are:

  • Pregnant or receiving postpartum Medicaid
  • In foster care (or were in the past)
  • American Indian or Alaska Native
  • A parent, guardian, or caregiver for a child age 13 or younger, or for a person with a disability
  • A veteran with a 100% disability
  • Medically frail or have special needs, including:
    • Blindness or a disability
    • A substance use disorder or mental health condition
    • A condition that makes it hard to do daily tasks
  • Subject to work requirements on the SNAP or TANF programs
  • Incarcerated currently
  • Participating in a drug or alcohol treatment and rehabilitation program

What if I am not an excluded individual?

If you do not meet an exclusion listed above, you must fulfill the community engagement requirement in at least one month since your last approval or renewal. The state will check your eligibility during the lookback months.

New members -  We look at your activities the month before you applied.

Current members - We look at your activities from your last renewal or approval until now.

 

Are there exceptions that meet the community engagement requirement?

Since your last review or approval, you may have already met the community engagement requirement if you:

  • You were under 19 years old
  • Are enrolled in Medicare part A or B
  • Received Title IV-E Foster Care/Guardianship
  • Received Supplemental Security Income (SSI)
  • Have been incarcerated at any time during the 3 months before your last approval or renewal
  • Received coverage under a different Medicaid program
  • Experienced one of the following hardships:
    • You were hospitalized or lived in a nursing home
    • You or your dependent had to travel for an extended amount of time for medical care that was not available in your area
    • You lived in a county while it had a declared national emergency or a very high unemployment rate

What do I need to do now?

You do not need to do anything right now. These changes do not start until January 1, 2027. We will send you more information and a renewal letter when it is time for you to take action. Please make sure your information is up-to-date.