Health advocates, hospital systems and Ohio residents on Medicaid are all bracing for one thing in coming months: new work requirements for people getting government-sponsored health insurance.
The Medicaid program — which insures about a quarter of residents across Ohio and close to one in three in Cuyahoga County — has never before required recipients to work.
But that will soon change as a result of a bill President Donald Trump signed into law last year.
This summer, Signal Cleveland shared the basics about the changes – but the specifics were still largely up in the air. Now, about three months before the rules take effect, the state and federal government have released more details about how residents can prove they meet work requirements or get exemptions from them.
It still isn’t all final – the rules are just a draft, so there are still some unknowns, said Tara Britton, the director of public policy and advocacy at the Cleveland-based Center for Community Solutions. There’s no concrete timeline for when the rules will be finalized, she said.
Below, we’ve included the latest information on the Medicaid work rules. Click on the question to jump to the answer.
What are Medicaid work requirements?
When will the work requirements start?
Who has to meet the work requirements?
Who is exempt from the work requirements?What proof do I need for exemptions?
How do I prove I meet the new requirements?
What documents can I submit to prove my work or volunteer hours?
Who counts as medically frail?
How do I prove I’m medically frail?
Can I sign a document saying I’m medically frail?
I’m applying for Medicaid. Can I start working after I get on the program?
What happens if I don’t meet the work requirements or qualify for an exemption?
What are Medicaid work requirements?
Work requirements mean that people receiving Medicaid will have to prove that they work, do community service or are enrolled in an education program for 80 hours a month.
This can include unpaid work like caregiving or working in exchange for goods and housing, said John Corlett, a senior visiting fellow at the Center for Community Solutions and the former Ohio Medicaid director, in a webinar.
Any combination of work, school and community service that adds up to 80 hours can count.
When will the new work requirements start in Ohio?
The work requirements must be implemented by Jan. 1, 2027.
States can request a “good faith” extension to delay until December 2028. A spokesperson said Ohio’s Department of Medicaid does not plan to ask for an extension.
Who has to meet the work requirements?
The work rules don’t apply to everyone who has Medicaid. Kids and seniors don’t have to comply. Instead, the work requirement will fall on people who are between 19 and 64 years old who get Medicaid because of their low income.
The work requirements don’t apply to residents who get Medicaid because they have a disability or are pregnant. It also doesn’t apply to people with Medicare or private insurance they get through work or the federal marketplace.
The state is notifying residents via mail if they will be subject to new work requirements. Residents can also log into Ohio’s Self-Service Benefit Portal to see if they are affected.
Who is exempt from the work requirements?
Outside of age and pregnancy, there are other ways to qualify for an exemption from work requirements. Those include:
- Being a current or former foster child under the age of 26
- Being a parent, guardian or caregiver of a disabled individual or of a dependent child 13 years of age and under
- Participating in a substance use disorder treatment program
- Being incarcerated or recently released from incarceration
- Meeting the SNAP or TANF work requirements
- Being “medically frail,” of which there is a definition below
A full list of exemptions is here
How do I prove I meet the new work requirements?
The state may be able to verify that you meet the new work requirements by using income records it already has.
You can pass the state’s income test if you earn at least $580 a month — the equivalent of working 80 hours at the federal minimum wage.
If you earn less than $580 a month, the state will estimate your work hours by dividing your income by the federal minimum wage.
Those residents — often students, gig workers, volunteers and people doing unpaid work — may have to provide more documents to show that they meet the work requirement, Corlett said.
What documents can I submit to prove my work or volunteer hours?
The state has a list of documents you can provide to your county’s Job and Family Service department to prove you meet the work requirement.
| Activity | Verification |
| Work or employment, including self-employment |
|
| Community Service |
|
| Work Program |
|
| Education and Training Activities |
|
Who counts as medically frail?
The State of Ohio is defining “medically frail” as people who:
- Are blind or disabled as defined by the Social Security Administration
- Have a substance use disorder
- Have a disabling mental disorder
- Have a physical, intellectual or developmental disability that significantly impairs ability to perform daily living activities
- Have a serious or complex medical condition that impacts their ability to meet the work requirement.
How do I prove I’m medically frail?
The state plans to automatically exempt people who are medically frail by using patients’ past medical records for certain indicators of serious or severe illness.
Ohio’s Department of Medicaid said it compiled a list of about 1,900 medical codes that will qualify someone as “medically frail.” That list isn’t public yet, though the state said they plan to publish it before work requirements go into effect next year. It did share a few examples:
- ICD-10 code A170 indicates tuberculosis meningitis – a complex medical need
- ICD-10 code F1010 indicates alcohol abuse, uncomplicated – a substance use disorder
- ICD-10 code F259 indicates Schizoaffective disorder, unspecified – a disabling mental disorder
- ICD -10 code Q909 indicates Down syndrome – a developmental disability
How will the state use these codes? In an August presentation, the state said it plans to review Medicaid recipients’ records for the prior year to see whether they received any of the diagnosis codes.
The state won’t have this information for residents applying to Medicaid for the first time. These individuals will need to provide documentation from a healthcare provider.
The state will accept this in “a range of formats.” But it’s not yet clear what exactly that looks like, Britton said.
Can I just sign a document saying I’m medically frail?
In the first year of work requirements, states are allowed to accept residents who declare or “self-attest” they are medically frail without providing proof. But Ohio is choosing not to allow that next year, Britton said.
That could change as the state finalizes how it will implement work requirements, she added.
What proof do I need for other exemptions?
Generally, the state will try to use records it already has to automatically verify an exemption. That should work for applicants who are current or former foster children, caregivers of young children, participating in drug and alcohol treatment programs or recently incarcerated.
If the state does not have information on file, it lists documents people can provide their county case worker to verify they should be exempt from work rules, according to information the state shared in August. (The list is subject to change as the federal government finalizes rules.)
| Exemption | Verification |
| Pregnant or postpartum |
|
| Parent or caretaker to child age 13 and under or disabled individual | Parent or caretaker to child age 13 and under:
|
| Current or former foster care child up to age 26 |
|
| Disabled veteran (rated as total) |
|
| Medically frail, including disability or hospitalization or serious illness |
|
| Drug or alcohol treatment |
|
| Incarcerated (current or released within prior 90 days) |
|
| Member of a Native American tribe |
|
I’m applying for Medicaid. Can I start working after I get on the program?
Caseworkers will review applicants’ work status before they join the program. The state plans to look at whether the applicant met the work requirement — or met an exemption — during the month before they applied, according to a presentation the state gave in August 2026.
When a person gets their Medicaid renewed – which will happen every six months starting next year – the state will review the prior six months to see whether the person met the work requirement. But, the person does not have to meet the requirement or exemption for all six months, according to August 2026 documents the state shared. They just need to meet the work requirement — or be exempt — for one month since the last renewal.
What happens if I don’t meet the work requirements or qualify for an exemption?
You may be denied or cut off from Medicaid benefits.
If that happens, patients will receive a state notice explaining the decision and information on how to request a state hearing on the application, Corlett said.
If Medicaid is discontinued, Corlett emphasized, residents can reapply for coverage at any time and aren’t subject to a waiting period — though they will be subject to the new rules.
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