Medicaid work rules begin Jan. 1, 2027: what a member must show to keep coverage

Starting Jan. 1, 2027, adults covered through Adult Expansion Medicaid or Targeted Adult Medicaid in Utah must show 80 hours a month of qualifying activity — a job, job training, school at least half time or volunteering — or earnings of at least $580 a month, to keep their coverage 123. The same members move from an annual eligibility review to one every six months 12.

Both changes come from H.R. 1, the One Big Beautiful Bill Act, which was signed on July 4, 2025 1. The federal rule behind the work requirement is an interim final rule that the Centers for Medicare & Medicaid Services issued on June 1, 2026, and states were required to implement it no later than Jan. 1, 2027 5.

The requirement applies to non-pregnant adults ages 19 to 64 in those two programs unless an exclusion applies 125. Members may combine activities to reach 80 hours in a month 45. The earnings alternative is set at 80 times the federal hourly minimum wage, which CMS puts at $580 a month for 2026; seasonal workers are measured on an average over six months 45.

**Who does not have to report**

Utah Medicaid's exclusion list covers pregnant members and those receiving postpartum coverage; people in foster care or formerly in it; American Indians and Alaska Natives; a parent, guardian or caregiver of a child age 13 or younger or of a person with a disability; a veteran with a 100% disability; members who are medically frail or have special needs, including blindness, a disability, a substance use disorder or a mental health condition; people receiving Social Security or SSI; people subject to SNAP or TANF work requirements; people incarcerated or released from jail within the last 90 days; and people enrolled in Medicare Part A or Part B 134.

Being under 19 is a mandatory exception, and the state offers optional short-term hardships that a member must request: inpatient or institutional care, travel outside the community for medical care for the member or a dependent, residence in a county under a federal emergency or disaster declaration, and residence in a county with high local unemployment 4. CMS describes the caregiver exclusion as covering children under 14, while the state's letter and table use age 13 or younger 345.

Verified American Indian and Alaska Native members keep the 12-month review cycle and do not have to meet the activity requirement 12. Members whose status is not verified can still be held to it; the state asks for a copy of a tribal identification or enrollment card, a Certificate of Degree of Indian Blood, an Indian Health Service record, a tribal court document or descendant documentation, with the member's name and case number on every page, sent by mail or fax to P.O. Box 143245, Salt Lake City, UT 84114-3245, before Jan. 1, 2027 1.

**Reviews twice a year, and a shorter lookback**

Adults in the two programs move to a review every six months; members in other Medicaid programs keep their existing renewal schedule 12. Voices for Utah Children put the number of adults shifting to the faster cycle at about 83,000, the Draper Herald reported 8.

Retroactive coverage also shrinks. Most programs previously allowed a member to request coverage for care received up to three months before applying; from Jan. 1 that window becomes one month for Adult Expansion Medicaid and two months for most other programs 2. Utah Medicaid advises members with unpaid bills or a medical emergency to submit an application as quickly as possible so the services can be covered 1.

**What happens when the state cannot verify**

Members must show compliance at application and at renewal 5. A state that cannot verify compliance must send a notice of noncompliance and give the member 30 calendar days to demonstrate compliance or an exemption; if the member does not, an application may be denied or the member disenrolled, and a disenrolled member may reapply at any time 5. Utah Medicaid says it will check the records it already holds first and tell members whether they need to report anything 3.

**One change already in effect**

Eligibility for some non-citizen groups narrowed on Oct. 1, 2026: refugees, asylees, humanitarian parolees and survivors of trafficking or domestic violence may no longer qualify, and eligibility is generally limited to U.S. citizens and nationals, green-card holders who have lived in the country at least five years, people from Cuba or Haiti who entered under special rules, and migrants from the Marshall Islands, Micronesia or Palau 12. Children and pregnant people may still qualify 1.

**Where to get help**

The state's H.R. 1 support page directs eligibility questions to the Department of Workforce Services at 1-866-435-7414, and general questions to a Medicaid Health Program Representative at 1-866-608-9422 6. Utah Medicaid's H.R. 1 page gives 1-877-543-7669 for questions about applying 1.

Take Care Utah, one of the co-hosts of a workshop on the changes, offers free help from Health Access Assisters by phone, online and in person, with multilingual support available statewide; it lists its number as 801-433-2299 and says its services are always free 7.

The member letter says recipients do not need to do anything yet, and asks them to confirm their address and phone number in the myCase portal at mycase.utah.gov so that notices arrive 3. It also warns that members who do not return forms or miss deadlines can lose coverage 1.

**The Nov. 11 workshops**

Molina Healthcare of Utah, Take Care Utah and Elevate Utah co-hosted a free workshop on Wednesday, Nov. 11, with an English presentation from 10 to 11 a.m. and a Spanish presentation from 11 a.m. to noon, the Draper Herald reported before the session 8. The Herald described it as a workshop for Draper-area residents; Elevate Utah, one of the co-hosts, gives its address as 650 W 100 N in Provo and describes its work as serving "the community in Utah County" 9. Both sessions ended before this article was published 8.

**What the state says comes next**

Utah Medicaid said in its H.R. 1 materials that it is "studying the new law and building tools to help affected Utahns," and that it is adding data sources to check eligibility automatically and increasing outreach to members 1. Members will receive more information and a renewal letter when it is time to act 3.