Medicaid work-requirement notices are going out. Many family caregivers are exempt.

A new federal rule requires some adults on Medicaid to show 80 hours a month of work, community service, job training or school to keep their coverage. States must start the requirement no later than Jan. 1, 2027, and the rule tells them to warn affected enrollees months in advance. That means many families may be getting letters about it now.

If you spend your days caring for a parent, spouse or child with a disability, read on. The rule exempts many family caregivers.

Who has to meet the requirement

According to CMS's fact sheet, the requirement applies to non-pregnant adults ages 19 to 64 who are covered through the Medicaid adult group (the "expansion" group) or certain similar state demonstrations, and who are not on Medicare. CMS says 43 states and the District of Columbia cover these adults and must carry out the requirement.

That means people on Medicare, including most older adults who receive home care, are not subject to it. The people most likely to be affected in a caregiving family are working-age relatives who get their own coverage through Medicaid.

You can meet the requirement in a given month by:

• working, doing community service, or taking part in a work program for at least 80 hours;
• being enrolled in school at least half time;
• combining these activities to reach 80 hours; or
• earning at least 80 times the federal minimum wage ($580 a month in 2026).

The caregiver exemption

The law exempts "parents, guardians, caretaker relatives, or family caregivers" of a dependent child 13 or younger or a disabled individual. The interim final rule fills in the details:

• "Disabled individual" uses the Americans with Disabilities Act definition of disability. The person you care for does not need to be on Medicaid or receive disability benefits to count.
• A family caregiver is exempt if any one of these applies: 1. You live with the person and provide help on a regular basis that is not just incidental. 2. You are a relative (for example a son, daughter, sibling, grandchild, niece or nephew) who provides regular, not-just-incidental help, even if you don't live with them. 3. You are not related and don't live with them, but provide at least 80 hours of help a month.

Under the rule, caregiving hours that fall short of that 80-hour mark for an unrelated person can still count toward the 80 hours of qualifying activity, as unpaid work.

Other exemptions include people who are medically frail, pregnant or postpartum, veterans with a total disability rating, former foster youth, and American Indians and Alaska Natives, among others.

Watch your mail

The rule requires states to send outreach notices before the requirement begins. For states starting Jan. 1, 2027, those first notices were due in July, August or September 2026, depending on the options each state chose. States must check compliance at application and renewal. If a state can't confirm that you meet the requirement or qualify for an exemption, it must send a notice and give you 30 days to respond. People who lose coverage can reapply at any time.

What to do now

• Open anything from your state Medicaid agency and note any deadlines.
• Ask how to report a caregiver exemption. Each state runs its own process, so ask your state Medicaid agency what proof it accepts.
• Keep simple records of the care you provide (what you help with and roughly how often), in case your state asks.
• If you get a noncompliance notice, respond within 30 days.

Rules and state processes are still being rolled out. Check details with your state Medicaid agency.