CMS launches nationwide framework to implement Medicaid work requirements

CMS issued an interim final rule on June 1, 2026 that creates a nationwide framework for states to implement Medicaid community engagement requirements for certain adults, according to the agency.

The rule generally requires 80 hours a month of qualifying work, education, community service or equivalent earnings. States must implement the requirement no later than January 1, 2027, for applicable populations.

CMS said the framework includes exemptions for groups such as pregnant and postpartum people, disabled or medically frail individuals, and some caregivers. It also sets verification procedures that states must use to confirm compliance or exemption.

Under the rule, people who cannot immediately verify compliance or an exemption must be given a 30-day period to show that they qualify before a denial or disenrollment can take effect.

The new guidance is the latest step in a policy that has drawn close scrutiny from health care groups and state officials because it affects how Medicaid eligibility will be checked and enforced. Trade coverage and Reuters both reported the rule’s rollout later on June 1.

What happens next will depend on how states choose to operationalize verification, exemptions and administrative systems before the January 1, 2027 deadline. CMS may also issue additional guidance before implementation begins.