Medicaid work requirements in 2027: notices and your right to a hearing

Checked against official sources: October 30, 2026.

What changes in 2027

  • A 2025 federal law adds work and community engagement rules for many adults in the Medicaid expansion group (ages 19 to 64), starting no later than January 1, 2027, unless HHS gives your state more time (no later than December 31, 2028). States may start earlier. It also requires eligibility checks every 6 months for these adults, for renewals scheduled on or after January 1, 2027. If the state cannot verify that you met the rule, it must send you a notice and give you 30 days from the day you receive it to show you did or that you are exempt, and keep your coverage during those 30 days. The notice counts as received 5 days after its date unless you show otherwise. Before it denies or ends your coverage, you must get a written notice and the right to a fair hearing.

Law: Pub. L. 119-21 (July 4, 2025), secs. 71107 and 71119 (42 U.S.C. 1396a(e)(14)(L), 1396a(xx)(1), (6), (11)); CMS interim final rule, 91 FR 33348 (June 3, 2026; correction 91 FR 39028, June 29, 2026), effective July 31, 2026; 42 CFR 435.558

Notice, hearing and keeping coverage

  • Before it cuts or ends your benefits, the state must usually send you a notice at least 10 days before the change takes effect.

    Law: 42 CFR 431.211

  • Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed. Check your notice: your state's deadline may be shorter.

    Law: 42 CFR 431.221(d)

  • If you ask for a hearing before the date the change takes effect, the state usually may not cut or end your services until the hearing decision. If you lose the hearing, the state may try to recover the cost of services you got only because of this rule.

    Law: 42 CFR 431.230

  • If you ask within 10 days after the change took effect, the state may restore your services until the decision. It must restore them if it did not send proper advance notice and you ask within 10 days of receiving the notice, unless the only issue is a change in federal or state law or policy. The notice counts as received 5 days after its date unless you show otherwise.

    Law: 42 CFR 431.231

Before you act

Keep every notice from your state Medicaid office and open your mail. If you get a notice, write down the date you got it and reply before the date in it.

Quick answers

When do the Medicaid work requirements start?

A 2025 federal law adds work and community engagement rules for many adults in the Medicaid expansion group (ages 19 to 64), starting no later than January 1, 2027, unless HHS gives your state more time (no later than December 31, 2028).

Can I ask for a hearing if Medicaid ends my coverage?

Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed. Check your notice: your state's deadline may be shorter.

Free help

Free help can look at your denial and your letters. Consumer assistance programs, legal aid groups and state insurance departments do not charge for this.

Free calculator and letters

Appeal deadline calculator

Letter: appeal to your plan

Letter: ask for external review

Letter: Medicaid fair hearing request

Sources