Policy & oversight
New Medicaid work rules skip Medicare
New nationwide Medicaid work requirements are rolling out, but people on Medicare, including those 65 and older and dual eligibles, are exempt. Here is who the rule touches and who it does not.
By the Goodsurance editorial teamJuly 1, 2026
On June 1, 2026, Medicare's parent agency issued a rule (known as CMS-2454-IFC) setting up nationwide Medicaid work requirements for the first time. Under the rule, certain adults ages 19 to 64 in the Medicaid expansion group must show 80 hours a month of work or similar activity to keep that coverage, and states have to put the requirement in place by January 1, 2027. Because Medicaid and Medicare are easy to mix up, and because millions of people have both, this news deserves one plain clarification: it does not apply to people on Medicare. The rule specifically exempts anyone entitled to or enrolled in Medicare, which means people 65 and older on Medicare, people under 65 who have Medicare through disability, and dual eligibles who carry both Medicare and Medicaid, including those in a dual eligible special needs plan, are not subject to the work requirement. Other groups are exempt too, among them pregnant and postpartum women, people who are disabled or medically frail, caregivers of young children, tribal members, and people already meeting similar rules through food or cash assistance programs. Why cover it at all if Medicare folks are exempt? Two reasons. Many Medicare households include a younger adult who is on Medicaid and could be affected, and dual eligibles hearing the headline may worry it touches their own coverage. The calm, useful fact is that it does not reach your Medicare.
New Medicaid work rules are coming, but people on Medicare, including 65 and older and dual eligibles, are exempt.
In plain words
Medicaid and Medicare sound alike, but they are different programs. A new rule adds work rules to Medicaid, not Medicare. On June 1, 2026, the government made a rule. It says some adults ages 19 to 64 on Medicaid must show 80 hours a month of work or similar activity to keep that coverage. States must start this by January 1, 2027. Here is the part to hear clearly. This does not apply to people on Medicare. If you are 65 or older on Medicare, or you have Medicare because of a disability, the work rule does not touch you. If you have both Medicare and Medicaid, it still does not apply to you. Other people are also excused, like pregnant women, people who are disabled, and caregivers of young children. So why mention it? Because it can affect a younger family member on Medicaid, and because the news can scare people who have both programs. The simple truth: your Medicare is not affected.
Understand the basics first
Source: Centers for Medicare and Medicaid Services
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