Medicaid work requirements set to take effect in over 40 states by end of 2026

Aug 26, 2026 - 16:20

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Over 66 million Americans receive health care through Medicaid, and new work requirements tied to President Donald Trump's signature legislation are expected to take effect in more than 40 states by the end of the year.

The changes stem from the "Big Beautiful Bill," which Trump signed into law. The legislation included policies such as Trump savings accounts and no taxes on tips, but new Medicaid rules were implemented to help offset the cost.

Among the biggest changes taking effect Jan. 1:

Non-citizens will be removed from Medicaid. Medicaid renewals will be required every 6 months instead of once a year. Adults between the ages of 19 and 64 who earn above a typical income cutoff and do not have children will be required to work or volunteer at least 80 hours a month, or enroll in school.

The Congressional Budget Office projects the changes will save taxpayers $388 billion over the next decade, but estimates 6 million fewer people will have health insurance as a result.

Eileen Appelbaum, who studies the changes at the Center for Economic and Policy Research, said many of those who lose coverage will still technically qualify for it.

"The best guesses from the experts are that two-thirds of the people that will be disqualified will actually be eligible, but they just couldn't handle the paperwork," Appelbaum said.

Republican House Speaker Mike Johnson defended the new rules, arguing they target fraud and misuse of the program.

"When you get able-bodied young men who are not eligible off the program, illegal aliens, for example, you save those resources," Johnson said.

Critics argue many states are not prepared to implement the new rules, which states can choose to enact early. Nebraska was the first to do so, removing 200 people from Medicaid in early August.

Appelbaum said the issue has not yet reached a fever pitch heading into the midterms, in part because many people are unaware of what is coming.

"You tell them their Medicaid is going away, they say, 'I still have my Medicaid, what are you talking about,;" Appelbaum said.

The changes are expected to become a larger issue on the campaign trail this fall.