This proposal would add a “community engagement” rule for many adults on Medicaid. To keep coverage, they would need to work, volunteer, or take part in a work program for at least 80 hours a month, or earn at least what 80 hours at the federal minimum wage would pay that month. If someone does not meet this for three or more months in a year, the federal government would stop paying its share of that person’s Medicaid costs for those months, and a state could choose to remove them from Medicaid for those months .

• Who is affected: Adults ages 18–65 on Medicaid, except people who are medically unfit to work, pregnant, caring for a child or an incapacitated person, already meeting work rules in another federal program, in a drug or alcohol treatment program, or enrolled at least half time in school.
• What counts: 80 hours/month of work, community service, a work program, or a mix of these; or monthly earnings equal to 80 hours at the federal minimum wage.
• How it’s checked: States should first use existing databases (like address, payroll, or other reliable records) before asking people for more paperwork.