Medicaid Work Requirements in New York, 2027: Who Must Report 80 Hours and Who Is Exempt

Who the rule reaches

The requirement is written for adults 19 to 64 who get Medicaid through the expansion group: working-age adults whose eligibility runs on income, the group that applies through NY State of Health rather than through the local department of social services.

It does not reach people 65 and older, children, or people on Medicaid because of a disability determination. It is a Medicaid rule; the city’s guidance describes it for Medicaid only, and we have seen no comparable requirement for the Essential Plan.

The date that matters most has already passed. NY State of Health said it would notify everyone the requirement applies to, by mail or email, by September 30, 2026. If you are 19 to 64, on Medicaid, and not sure whether you got that notice, log in to your NY State of Health account or call and ask. A missing letter is more often a stale address than a sign that you are exempt.

What counts: 80 hours or $580

You meet the rule in a month with 80 hours of any combination of:

Or with monthly income of at least $580, which is 80 hours at the federal minimum wage. That second route matters for people paid by the job rather than by the hour.

Hours can be mixed inside a month. A parent working 50 hours and in a training course the rest counts.

Proving it with less paperwork. NY State of Health is partnering with a company called Truv to read payroll data, if you opt in, so that work can be verified without pay stubs. It is optional. If you would rather send documents yourself, keep them anyway.

Who is exempt

The city’s Health Department lists these exemptions, with the full list on NY State of Health’s Stay Covered page:

• Pregnant, or pregnant within the past 12 months
• The parent, guardian or caregiver of a child under 14, or of a disabled individual
• A disability as defined for SSI
• Special medical needs or mental health conditions that significantly impair your ability to work, often called “medically frail”
• Taking part in a drug or alcohol treatment program
• Enrolled in SNAP and subject to its work rules, or in TANF and complying with its work rules
• Released from jail or prison in the last 90 days
• Receiving inpatient services in a hospital, nursing facility or similar facility

Some people will be exempted automatically from data the state already has. Others will have to show it. In 2027 the state will accept self-attestation for certain exemptions, including medically frail; the city says that is restricted from 2028. So if your exemption rests on a medical condition, get a provider’s letter on file now, while it is simplest.

When it reaches you

If you are applying: the rule applies from January 2027. Applying with proof of hours or proof of an exemption in hand is faster than being asked for it.

If you already have Medicaid: it applies at your renewal, starting with renewals from March 1, 2027. Your renewal notice is where the question will be asked. How Medicaid renewals go wrong.

More renewals: some adults 19 to 64 will renew every six months instead of once a year. Each renewal is a letter that has to reach you and be answered.

If the state cannot verify: you get a notice of noncompliance and a short window to show that you met the rule or that an exemption applies. If nothing comes back, coverage can end. That notice will not look dramatic. Open everything from NY State of Health.

What to do now

If coverage ends anyway

Keep getting care. Losing Medicaid does not close the doors that do not depend on it: NYC Care at the city’s public hospitals, 1-646-NYC-CARE, with no immigration requirement, and community health centers with sliding-scale fees. Reapply as soon as you can show hours or an exemption. And for any hospital bill from the gap, New York’s hospital financial assistance law caps what you can be charged up to 400% of the poverty level.