Center on Budget and Policy Priorities November 3, 2025
The reconciliation law enacted in July, known as HR 1, requires certain Medicaid applicants and enrollees to document at least 80 hours per month of “community engagement,” consisting of work or other qualifying activities, or qualify for an exemption.[1] Enrollees who cannot meet this work requirement or qualify for an exemption will have their coverage taken away; applicants who cannot meet it will be denied coverage. While past experience shows that this requirement will lead many people to lose coverage, state policy and implementation choices will largely determine how many people lose coverage.[2] States can substantially mitigate coverage loss from the work requirement by choosing policies that minimize burden, streamlining verification processes, and creating accessible and user-friendly forms, portals, and...
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