Federal Work Requirements

A new federal law is changing Medicaid rules for some adults. Beginning January 1, 2027, some adults will need to meet a work requirement to qualify for Medicaid. These same adults will also have their coverage reviewed every 6 months, instead of every 12 months. These requirements do not apply to everyone who has Medicaid.

Who Does This Affect?

The new work requirement applies only to members with Medicaid Expansion coverage. That means adults:

•  Ages 19-64
• With incomes under 138% of the federal poverty level (around $22,000/year for an individual or $45,000/year for an adult in a family of four)
• Who are not eligible for Medicare

The work requirement DOES NOT apply to other types of Medicaid, such as coverage for children, pregnant or postpartum individuals, adults with a disability, or individuals ages 65 or above. 

Current members received a letter by the end of September 2026 telling them about the new work requirement, how to meet it, and available exemptions.

Exemptions

You do not need to meet the work requirement if any of the below describe you:

• Parents, guardians, or caregivers of a child under 14, or of a person (of any age) with a disability
• Pregnant or within 12 months postpartum
• Individuals with a serious medical condition, serious mental health condition, substance use disorder, or physical, intellectual or developmental disability or blindness
• Individuals receiving participating in a substance use disorder treatment drug or alcohol rehabilitation or treatment program
• People who left foster care at age 18 and are currently 25 or younger
• Members of federally recognized tribes
• Veterans with a 100% disability rating
• People who are incarcerated (jail or prison) or were released in the last 3 months
• Residing in a locality (city or county) with a high unemployment rate, or with a federal disaster or emergency declaration
• Received inpatient, nursing home, institutional, or other similar care
• Received necessary care for yourself or a dependent outside your community for a serious medical condition

Meeting the Work Requirement 

Individuals can meet the work requirement through:

•        Work, job training, education, and/or volunteering for at least 80 hours (including any combination of those activities)
•        Enrolling in school (including high school, GED program, higher education, career, and technical education) at least half time
•        Earning at least $580 per month

When you do these activities matters. To meet the work requirement, individuals must have worked, gone to school, been in a work program, volunteered, or earned $580 during a specific month:

• For applicants: the month immediately before they apply.
• For current members: at least one month since their last renewal or enrollment.

When Does this Requirement Take Effect?

The new work requirement will take effect in 2027. This means:

• Applicants applying on or after January 1, 2027.
• Members will be checked for the work requirement as they come up for renewal. The work requirement will apply to renewals scheduled for March 31, 2027 or later.   

How Do I Report an Exemption, Work, or Other Activity?

As much as possible, Virginia Medicaid will use the information we have to automatically determine whether someone is eligible for Medicaid. If we need additional information, we will reach out.

In 2027, in most cases, the information you put on your application or renewal will be all you need to show you qualify for an exemption or have met the work requirement. (This is also sometimes called “self-attestation”). We will let you know if we need more information. Additional requirements will apply in 2028.

What Should I Do Now?
Members should ensure that Virginia Medicaid has their updated contact information to receive important communications from Virginia Medicaid. 

Changes to contact information can be reported:

• Online at commonhelp.virginia.gov 
• By calling Cover Virginia at 855-242-8282 (TTY: 888-221-1590).

 
More information will be added to this webpage as Virginia Medicaid continues implementing these changes.