Medicaid Work Requirements Go Live Soon. Here’s How Many Could Lose Coverage

Work-reporting rules apply to ACA expansion adults ages 19–64—about 20 million people across 41 states and D.C.

To stay eligible, enrollees must document 80 hours per month of work, training, education or community service; states verify compliance every six months.

Exemptions include parents of children 13 or younger, pregnant women, those deemed medically frail, and people already subject to SNAP work rules.

Several states are moving up start dates: Montana begins July 1 (six months early) and has a new preparation resource; Nebraska may enforce as early as May 1; Arizona, Arkansas, Iowa, Ohio, South Carolina and Utah also plan early launches.

Projected impacts: Montana ~31,000 and Nebraska ~30,000 could lose coverage; the CBO estimates the work-reporting rule alone would add 5.3 million uninsured by 2034, and 7.5 million when combined with other Medicaid changes.