States must have Medicaid work requirements running by January 1, 2027
Congress, enforced by CMS (One Big Beautiful Bill Act)
Health & Environment Active Updated Jul 7, 2026
The Medicaid work rules
The 2025 federal reconciliation law created the first national Medicaid work requirement: 80 hours a month of work, school, or service for expansion adults, in force by January 1, 2027. State officials expect at least 475,000 New Yorkers to lose Medicaid, on top of roughly 450,000 who lost Essential Plan coverage on July 1, 2026. Attorney General James is suing over the federal rule while city health officials scramble to keep New Yorkers enrolled.
The story so far
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Jul 7, 2026 Latest
NYC health officials publicly warned that federal Medicaid work requirements are arriving and will strip coverage from tens of thousands of New Yorkers who cannot document employment, with one official telling Gothamist 'yes, this does suck.' The city is bracing for implementation with no announced workaround or state waiver in place.
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Jun 29, 2026
Attorney General Letitia James and officials from two dozen states sued in Boston federal court, arguing the rule invents a standard the law never contained by making medically vulnerable people prove their conditions significantly impair their ability to work. The state says at least 475,000 New Yorkers could lose Medicaid, swelling the uninsured population by 45%. "New Yorkers who are battling cancer, living with a disability, managing a serious mental health condition, or recovering from addiction should be able to get the health care they need without being buried in paperwork," James said.
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Jun 1, 2026
CMS issued the interim final rule: 80 hours a month or equivalent earnings, exemptions for pregnant women, caregivers, and the medically frail, effective July 31, 2026, with states on the hook by January 1, 2027. States may accept self-attestation of exemptions in 2027 but generally must demand documentation starting in 2028.
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May 28, 2026
Hochul signed a $268.5 billion state budget nearly two months late, with $1.5 billion more for hospitals, nursing homes, and clinics and a record $14.9 billion Essential Plan appropriation, but no state backfill for the roughly 450,000 New Yorkers losing Essential Plan coverage on July 1.
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Apr 1, 2026
The state began mailing notices to roughly 450,000 Essential Plan enrollees earning between 200% and 250% of the poverty line, about $32,000 to $40,000 a year for a single person, telling them their coverage would end July 1. Marketplace shopping for replacement plans opened May 16 with an August 30 deadline.
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Dec 10, 2025
State Comptroller Thomas DiNapoli reported that the city Department of Social Services expects 950,000 city residents to lose health coverage under the law, 800,000 from Medicaid and 150,000 from the Essential Plan, and flagged federal cuts of up to $622 million aimed at NYC Health + Hospitals.
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Dec 8, 2025
CMS issued its first implementation guidance, telling states to verify work compliance through existing payroll and enrollment data before demanding paperwork, to give enrollees 30 days' notice before any cutoff, and to be running by January 1, 2027, with good-faith extensions available through the end of 2028.
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Jul 11, 2025
Gov. Hochul's office put numbers on the law for New York: more than 2 million people losing current coverage, 1.5 million becoming uninsured, 730,000 lawfully present immigrants cut from the Essential Plan, a $13 billion annual hit to the state and its health care system, and $3 billion a year in new uncompensated care landing on hospitals.
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Jul 4, 2025
President Trump signed the law on July 4 after the Senate passed it 51 to 50 on Vice President JD Vance's tiebreaker. States got until January 1, 2027 to stand up the work requirement, HHS got a June 1, 2026 deadline to issue rules, and the Congressional Budget Office projected the provisions would save $326 billion over ten years while leaving roughly 4.8 million more people uninsured by 2034.
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May 22, 2025
The House passed the One Big Beautiful Bill Act 215 to 214, carrying the first national Medicaid work requirement: adults ages 19 to 64 covered through the ACA expansion must log 80 hours a month of work, community service, or half-time schooling to keep coverage, with exemptions for parents of children 13 and under, pregnant women, and the medically frail.
On the record
The checkable commitments in this fight, tracked until they are kept or broken.
The CMS rule forcing sick New Yorkers to prove they cannot work will be struck down in court
Attorney General Letitia James and a multistate coalition
“New Yorkers who are battling cancer, living with a disability, managing a serious mental health condition, or recovering from addiction should be able to get the health care they need without being buried in paperwork.”
The city will use $3 million for community health workers to keep New Yorkers enrolled under the work rules
Alister Martin, NYC health commissioner
HHS will issue Medicaid work-requirement rules by June 1, 2026
Congress (statutory deadline for HHS)
CMS issued the interim final rule on June 1, 2026 and published it June 3, codifying the 80-hour monthly standard effective July 31, 2026.
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