--- title: What are the Medicaid work requirements under HR 1? description: Learn about the Medicaid work requirements under HR 1, effective January 1, 2027, and their impact on hospital revenue cycle operations. image: https://insights.getixhealth.com/hubfs/Medicaid%20Work%20Requirements%20Infographic%20Desk%20Scene.png --- [Skip to main content](https://insights.getixhealth.com/rcm-answers/what-are-the-medicaid-work-requirements-under-hr-1#main-content) [![Getix Health](https://insights.getixhealth.com/hs-fs/hubfs/raw_assets/public/GetixHealth%20Theme%20February2024%20%5BCLEANUP%5D/images/GetixHealth_Logo.png?width=184&height=298&name=GetixHealth_Logo.png "Getix Health")](https://insights.getixhealth.com/) - [Solutions](https://getixhealth.com/solutions.html) - [Patient Access](https://getixhealth.com/solutions/patient-access.html) - [Eligibility & Enrollment](https://getixhealth.com/solutions/eligibility.html) - [Workers’ Compensation](https://getixhealth.com/solutions/workers-compensation.html) - [Insurance Resolution](https://getixhealth.com/solutions/insurance-resolution.html) - [Medical Coding](https://getixhealth.com/solutions/chart-coding-audits.html) - [Early Out Self Pay](https://getixhealth.com/solutions/self-pay-patient-billing.html) - [Professional RCM Services](https://getixhealth.com/solutions/professional-rcm-services.html) - [Insights](https://insights.getixhealth.com) - [Company News](https://insights.getixhealth.com/company-news) - [Blog](https://insights.getixhealth.com/blog) - [Podcast](https://insights.getixhealth.com/podcast) - [RCM Answers](https://insights.getixhealth.com/rcm-answers) - About - [Our Company](https://getixhealth.com/about.html) - [Our Technology](https://getixhealth.com/technology.html) [Let’s Talk](https://insights.getixhealth.com/rcm-answers/what-are-the-medicaid-work-requirements-under-hr-1#gh_form_id) [RCM Answers](https://insights.getixhealth.com/rcm-answers) Answer # What are the Medicaid work requirements under HR 1? Alex Oey· Updated November 9, 2026 [Podcast Episode 17View all episode content→](https://insights.getixhealth.com/?tag=podcast-episode-17) Short answer Learn about the Medicaid work requirements under HR 1, effective January 1, 2027, and their impact on hospital revenue cycle operations. ## Why It Matters The community engagement requirement is one of the most operationally disruptive provisions in HR 1 for hospital revenue cycle teams. Internal analysis cited by Jorge Rodriguez, Vice President of Operations for the ePALS team at GetixHealth, found that 25 percent of uninsured inpatient expansion adults his team helped enroll in Medicaid reported zero income. Under the new rules, every one of those patients will need to either document a qualifying activity or qualify for an exemption to maintain coverage. For hospitals, that changes the economics of bedside screening. Collecting work verification or exemption documentation is a documentation-heavy process that is far harder to complete once a patient has been discharged. Rodriguez notes that when an inpatient leaves the facility before screening, interview, and application support occur, hospitals lose more than 50 percent of their chances of resolving the case. With work requirements layered on top, that gap widens. The financial exposure is concrete. Average inpatient charges referenced in the discussion range from $80,000 to $140,000, and trauma facility accounts commonly exceed $200,000. A single uncovered expansion-adult admission can therefore represent a six-figure write-off. ## Key Takeaways - The threshold is 80 hours per month of work, school, volunteering, or another qualified activity, or at least $580 per month in earnings. - The rule applies to Medicaid expansion adults, generally defined as non-disabled adults ages 19 to 64 in expansion states. - The effective date is January 1, 2027. - Federal mandated exemptions exist, and states may adopt additional optional exemptions. The specific exemptions a state adopts, and how counties interpret acceptable documentation, vary by state. - Medicare beneficiaries and other non-expansion populations are not subject to the work requirement. - Work requirements are tied to the new six-month renewal cycle, meaning enrollees must demonstrate compliance (or an exemption) at each redetermination, not just at initial application. - Bedside screening before discharge becomes the operational control point for collecting verification or exemption documentation. ## Expert Perspective Rodriguez frames the work requirement as a shift in where eligibility work has to happen inside the hospital. "You have to have a solid experienced patient advocacy team and enrollment support strategy to make sure that effectively you can identify and apply these exemptions," he said during the webinar. His recommendation is that hospitals aim for a 98 to 100 percent bedside screening rate on in-house inpatients, because post-discharge outreach is unlikely to produce the documentation needed to satisfy work verification or exemption requirements. He also emphasized that state-level interpretation will drive day-to-day operations. His team has been meeting directly with county eligibility offices to understand which verifications will be accepted, and he recommends hospitals do the same rather than waiting for formal guidance to settle. A common mistake Rodriguez identified is assuming that the hybrid financial counselor model many hospitals adopted during COVID-era simplification will carry forward. "What you're doing today is not going to work with these new rules," he said. The reintroduction of pre-ACA-style complexity, including field verification and documentation gathering, requires deeper Medicaid expertise than many internal teams and newer vendors currently have. ## Related Resources [**Related Podcast Episode**](https://insights.getixhealth.com/podcast/one-big-beautiful-bill-webinar-recording) One Big Beautiful Bill Webinar: What HR 1 Means for Hospital Medicaid Enrollment ## Frequently Asked Questions **Who is subject to the HR 1 Medicaid work requirement?** The requirement applies to Medicaid expansion adults, generally non-disabled individuals ages 19 to 64 who became eligible for Medicaid under ACA expansion. Medicare beneficiaries, pregnant women, and other categorical eligibility groups are not subject to the work rule. **What counts as a qualifying activity?** Work, school attendance, volunteering, or participation in another qualified activity totaling at least 80 hours per month. Alternatively, earned income of at least $580 per month satisfies the requirement. **When does the work requirement take effect?** January 1, 2027. States may implement operational elements on different timelines, so hospitals should confirm specifics with their state Medicaid agency and county offices. **What exemptions are available?** HR 1 establishes federal mandated exemptions, and states may adopt additional optional exemptions. The specific list of state-adopted exemptions and the documentation each requires varies by state and is still being finalized in many jurisdictions. **How do work requirements interact with the new six-month renewals?** Expansion adults subject to the work rule must demonstrate compliance (or qualify for an exemption) at each six-month redetermination. This creates a recurring verification burden rather than a one-time check at initial enrollment. **Why is bedside screening important for the work requirement?** Collecting work verification or exemption documentation requires patient interviews and supporting records that are difficult to obtain after discharge. Internal data cited by Rodriguez indicates hospitals lose more than 50 percent of case resolution opportunities when patients are discharged before eligibility screening occurs. **Do non-expansion states need to prepare for the work requirement?** Non-expansion states will not be directly affected by the work rule because they do not cover the expansion adult population. However, non-expansion states are still affected by other HR 1 provisions, including the shorter two-month retroactive coverage window and changes to coverage for certain non-citizens. **What percentage of expansion adults may need an exemption?** Based on GetixHealth internal analysis across its hospital partners, 25 percent of uninsured inpatient expansion adults assisted with Medicaid applications reported zero income and would need to meet either a federal or state exemption to qualify under the new rules. ## Where to next? [Answer How often will Medicaid expansion adults have to renew under HR 1?](https://insights.getixhealth.com/rcm-answers/how-often-will-medicaid-expansion-adults-have-to-renew-under-hr-1) [Answer Where should AI be used in the revenue cycle - and where shouldn't it?](https://insights.getixhealth.com/rcm-answers/where-should-ai-be-used-in-the-revenue-cycle-and-where-shouldnt-it) [Podcast Episode One Big Beautiful Bill Webinar](https://insights.getixhealth.com/podcast/one-big-beautiful-bill-webinar-recording) [Podcast Episode Insights from a Revenue Cycle VP: Establishing Operations at a New Organization](https://insights.getixhealth.com/podcast/revenue-cycle-insights) [Article Patient Access Is Your Pre-Billing Department. Fund It That Way.](https://insights.getixhealth.com/blog/patient-access-is-your-pre-billing-department-fund-it-that-way) [Article Bringing Spreadsheets to an AI Fight: The Provider-Payer Automation Gap](https://insights.getixhealth.com/blog/bringing-spreadsheets-to-an-ai-fight-the-provider-payer-automation-gap) [← Browse all answers](https://insights.getixhealth.com/rcm-answers) [![Getix Health](https://insights.getixhealth.com/hubfs/raw_assets/public/GetixHealth%20Theme%20February2024%20%5BCLEANUP%5D/images/GetixHealth_white.svg "Getix Health")](https://insights.getixhealth.com/) 14141 Southwest Freeway Suite 300 Sugar Land, TX United States, 77478 - [Solution](https://getixhealth.com/solutions.html) - [Patient Access](https://getixhealth.com/solutions/patient-access.html) - [Insurance Resolution](https://getixhealth.com/solutions/insurance-resolution.html) - [Chart & Coding Audits](https://getixhealth.com/solutions/chart-coding-audits.html) - [Eligibility & Enrollment](https://getixhealth.com/solutions/eligibility.html) - [Self Pay Patient Billing](https://getixhealth.com/solutions/self-pay-patient-billing.html) - [Workers’ Compensation](https://getixhealth.com/solutions/workers-compensation.html) - [Professional RCM Services](https://getixhealth.com/solutions/professional-rcm-services.html) - [Solutions](https://getixhealth.com/solutions.html) - [Technology](https://getixhealth.com/technology.html) - [Careers](https://getixhealth.com/careers.html) - [Contact](https://getixhealth.com/contact.html) - Learn - [Blog](https://insights.getixhealth.com/blog) - [Podcast](https://insights.getixhealth.com/podcast) ### The core behind care. © 2026 GetixHealth. 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