Medicaid work rule: 80 hours a month required in 44 states from Jan. 1, 2027

ACA Medicaid expansion enrollees and certain Section 1115 waiver enrollees in 44 states must complete at least 80 hours per month of work, community service or a work program by Jan. 1, 2027, under HR 1, the One Big Beautiful Bill Act signed July 4, 2025. States may start earlier. The rule affects part of Medicaid's 82 million enrollees.