Medicaid work requirement enforcement delayed until July 2027

Published on November 14, 2026

The Centers for Medicare & Medicaid Services (CMS) has given states six additional months before they must remove people from Medicaid for failing a new work requirement. The requirement still formally takes effect on January 1, but states that use the extra time will not have to deny or end anyone’s coverage for failing the rule until July 1, 2027. CMS called the optional window a hold harmless period. ¹

The rule requires many adults under 65 to work, volunteer or attend school at least 80 hours a month to keep Medicaid. It applies only to people covered under the voluntary expansion that 40 states adopted for lower-income adults without children at home, with exemptions for people over 64, parents of children under 14 and the medically frail. States must still begin determining whether enrollees and applicants meet the requirement.

States may use the additional time to prepare. It is not yet clear which states will use it.