Trump Administration Announces 2027 Medicaid Work Requirements Affecting Nearly 5 Million

On November 3, 2025, Trump administration officials announced new Medicaid work requirement rules taking effect January 1, 2027, requiring proof of 80 monthly hours of work, study, volunteering, or other approved activities to maintain health coverage. The Trump Tyranny Tracker reported the requirements could potentially cut Medicaid coverage for nearly 5 million people. The policy implements provisions from the “One Big Beautiful Bill Act” signed July 4, 2025, which established the first-ever national work requirements for Medicaid. According to KFF analysis, able-bodied adults not otherwise exempted must complete at least 80 hours per month (20 hours per week) of qualifying community engagement activities. Qualifying activities include working, participating in work programs or community service, enrolling in education programs, or earning monthly income at least equal to minimum wage multiplied by 80 hours. States are awaiting CMS guidance, which the law requires by June 2026. Earlier Congressional Budget Office analysis estimated 18.5 million people will be subject to the requirements annually, with federal Medicaid coverage decreasing by an estimated 5.2 million adults by 2034, ultimately increasing the number of uninsured by 4.8 million. Several states including Arizona, Arkansas, Iowa, and Ohio have already submitted Section 1115 waivers to add work requirements. The policy weaponizes healthcare access as a punitive measure against low-income Americans, imposing bureaucratic obstacles that will cause millions to lose coverage even if they meet work requirements due to documentation failures.