Effective Jan. 1, 2027, 42 states and the District of Columbia must implement Medicaid work requirements. Nebraska, Montana, and Iowa started earlier.

The Centers for Medicare and Medicaid Services announced new Medicaid work requirement rules for 42 states and the District of Columbia on June 1. The rules are open for comment until July 31.

The jurisdictions—which exclude Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming—are those that have adopted full or partial Medicaid expansion, covering adults with incomes up to 138 percent of the federal poverty level, resulting in a coverage limit of $21,597 for an individual in 2025.

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