Medicaid's 80-Hour Rule: Who Must Comply by 2027

Adults covered by the ACA's Medicaid expansion, plus some in Section 1115 pilot programs, in 44 states must complete 80 hours a month of work, volunteering or training by Jan. 1, 2027. The requirement is from HR 1, the One Big Beautiful Bill Act signed July 4, 2025. States may start earlier. It affects part of Medicaid's 82 million enrollees.