10 ways to be exempt from Medicaid’s new 80-hour work rule

Starting July 31, a new federal rule will require certain adults on Medicaid to show at least 80 hours a month of work, community service, a work program, or half-time-plus school, or income of at least $580 in the month. It reaches a specific slice: adults 19-64 covered through ACA expansion in the 40 states and D.C. that adopted it. If you are 65 or older, on Medicare, pregnant, or on a disability or aged pathway, it does not touch you. States have until January 1, 2027 to implement. The regulation names ten groups it simply does not apply to. For them, in the rule's own words, "community engagement is not a condition of eligibility."

What the 80-Hour Rule Actually Is

Adults must complete one of these: 80 hours of paid work, 80 hours of community service, 80 hours in a work program, half-time-plus education, any combination totaling 80, monthly income of at least $580 (federal minimum wage times 80), or a six-month seasonal average. "Work" includes in-kind and unpaid work. The rule reaches the ACA expansion group in 40 states and D.C.. KFF, citing CBO, projects roughly 5.2 million fewer Medicaid enrollees by 2034, driven mostly by reporting failures, even though 64% of Medicaid adults 19-64 already work.

What "Exempt" Means

The regulation is direct: "Community engagement is not a condition of eligibility for specified excluded individuals." For people in the ten categories, the requirement never applies. This differs from a hardship exception, which is a state option and usually must be requested.

The Ten Groups Exempt From the Rule

1. Former foster care youth, "regardless of whether the individual turned age 18 on or after January 1, 2023."
2. American Indians and Alaska Natives, using the definition of Indian at 42 CFR 447.51.
3. A parent, guardian, caretaker relative, or family caregiver (details below).
4. Veterans rated 100% (total) disabled by the VA under 38 U.S.C. 1155, temporary or permanent. A 70% rating does not qualify by this route.
5. Medically frail individuals. Two-part test: a condition that significantly impairs ability to comply AND falls in a listed sub-category (blind or disabled under SSA §1614; substance use disorder, excluding stable 5+ year recovery; disabling mental disorder; physical, intellectual, or developmental disability impairing activities of daily living; serious or complex condition). States must publish a conditions list and allow someone whose condition is not listed to request consideration.
6. People complying with TANF work requirements (SSA §407).
7. People in a SNAP household subject to SNAP work requirements.
8. People in drug or alcohol treatment and rehabilitation (7 U.S.C. 2012(h)).
9. Inmates of a public institution (42 CFR 435.1010).
10. People who are pregnant or entitled to postpartum assistance (SSA §1902(e)(5) or (e)(16)).

Category No. 3: The Caregiver Exemption

A parent of a child under 18 is exempt. A parent of a 14-year-old is not exempt through this door.

Caregivers of a disabled individual also qualify. Verbatim: "Disabled individual means an individual who meets the Americans with Disabilities Act definition of disability at 28 CFR 35.108. An individual need not be eligible for Medicaid or other Federal programs on the basis of a disability to be a disabled individual under this definition." No age limit and no separate disability determination. A family caregiver qualifies if they (A) primarily reside with the person and give regular, not-solely-incidental assistance; (B) are a relative not living with them giving that same assistance; or (C) neither live with nor are related to the person but provide at least 80 hours a month of such assistance. More than one person in a household can qualify.

What's Not on the List

There is no student exemption. Education counts only as a qualifying activity. Half-time-plus satisfies the rule; below that, credit hours convert to monthly hours. CMS's own example: 6 credit hours equals about 78 monthly hours, just under 80. Recent release from incarceration is also not on the list. Being an inmate is No. 9. A separate provision, §435.553(b), deems you compliant if you were an inmate any time in the three-month period ending the first day of the month.

Three Additional Paths to Compliance

1. Mandatory exceptions (§435.553). The state must deem you compliant if, for any part of the month, you were under 19; entitled to or enrolled in Medicare Part A or B; in a mandatory group under SSA §1902(a)(10)(A)(i)(I) through (VII); or within the three-month post-incarceration lookback.
2. State hardship exception (§435.555), optional and varies by state. Categories include inpatient hospital, nursing, ICF-IID, or psychiatric care of similar acuity; a county under a presidentially declared emergency; county unemployment at or above the lesser of 8% or 1.5x the national rate; or the need to travel outside your community for extended treatment of a serious or complex condition unavailable locally.
3. Meet the requirement. Income of at least $580 in a month satisfies the rule regardless of hours worked.

States Must Check Records First

§435.557(b) requires the state to use reliable available information before asking you for anything. §435.557(b)(2)(iii)(B) bars terminating or denying you solely because documentation does not exist or is not reasonably available. Ignore a notice and you will lose coverage anyway.

If Verification Fails

You get a notice of noncompliance and 30 calendar days from receipt to respond. The notice is deemed received five days after its date, rebuttable, so about 35 days in practice. Disenrollment cannot happen later than the end of the month following the month the 30 days ends, and only after advance written notice and fair hearing rights. You can reapply anytime; the rule contains no lockout. Deal with your own state Medicaid agency.

Litigation Ahead

This is an interim final rule, and the comment period closes July 31, 2026, the same day it takes effect. More than two dozen states and D.C. are suing in Commonwealth of Massachusetts v. Oz, No. 1:26-cv-12962-DLC, D. Mass., with a preliminary-injunction hearing set for July 28, 2026 at 2:00 p.m. before Judge Richard G. Stearns. Nothing has been enjoined. Prepare as if the rule takes effect on schedule, and watch that docket.

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