CMS issues interim final rule on Medicaid community engagement (work) requirements

On June 1, 2026, the Centers for Medicare & Medicaid Services issued an interim final rule with comment period implementing Medicaid community engagement (work) requirements for adults in the ACA expansion population. Under the rule, certain enrollees must complete 80 hours per month of qualifying activities — employment, education, community service, or work programs — or meet equivalent income thresholds, with states required to implement no later than January 1, 2027. The rule maintains exemptions for people who are pregnant or postpartum, disabled or medically frail, and caregivers, and allows short-term hardship exemptions. CMS projects the rule will reduce Medicaid enrollment by 2.3 million people in FY2027 and over 3 million in subsequent years.