Overview
- CMS released the 387-page interim final rule on Monday, June 1, 2026, telling states to require most adults in the Medicaid expansion group to show 80 hours per month of work, school, or community service to keep benefits.
- The rule lists statutory exemptions such as pregnancy, caregivers of young children, SNAP work-compliant recipients, and people deemed 'medically frail,' but it narrows that medical test to conditions that significantly impair at least one activity of daily living.
- Beneficiaries may self-attest to meeting the requirement or an exemption through 2027, and beginning in 2028 states will move to routine documentation and verification with limited allowance for one-time attestation.
- CMS is offering about $200 million in grants and promises technical help, yet states warn the Jan. 1, 2027 deadline, staffing needs, and IT upgrades will strain budgets and risk administrative errors that could drop people from coverage.
- Independent analyses and advocates point to Arkansas’ 2018 experience and CBO, KFF, and Urban Institute estimates to warn that paperwork and verification failures—not joblessness—could leave millions uninsured, and the rule is open for public comment through late July 2026.