New Medicaid Work Rules Likely to Hit Middle-Aged Adults Hard

Adults ages 50 to 64, particularly women, are likely to be impacted by the new requirements.

Published on Feb. 24, 2026

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Starting next January, some 20 million low-income Americans in 42 states and Washington, D.C. will need to meet new Medicaid work requirements to gain or keep their health coverage. The rules are expected to result in at least 5 million fewer people with Medicaid over the next decade, with middle-aged adults, especially women, being hit the hardest.

Why it matters

The new Medicaid work requirements could disrupt access to care for vulnerable populations, including those with chronic health conditions and family caregivers. Experts warn that making it harder for people to maintain Medicaid coverage may actually undermine their ability to work by leaving health problems untreated.

The details

The new rules require Medicaid recipients to work, volunteer, attend school, or perform other qualifying activities for at least 80 hours per month. Exempt are people with disabilities, caregivers, pregnant and postpartum individuals, veterans with total disabilities, and others facing medical or personal hardship. However, the caregiver exemption is considered 'very narrow', raising concerns that some who should qualify will fall through the cracks.

  • The new Medicaid work requirements will take effect starting in January 2027.
  • The Congressional Budget Office predicts the work rules will result in at least 5 million fewer people with Medicaid coverage over the next decade.

The players

Lori Kelley

A 59-year-old resident of Harrisburg, North Carolina who has deteriorating vision that has made it difficult for her to find steady work. She currently survives on less than $10,000 per year and relies on Medicaid to pay for her medications and doctor visits.

Jane Tavares

A gerontology researcher at the University of Massachusetts Boston who says the work requirements are 'just a tool' to save money 'at the expense of people's lives'.

Paula Wallace

A 63-year-old resident of Chidester, Arkansas who recently gained Medicaid coverage through her state's expansion, but is concerned about how she will be able to comply with the new work requirements while serving as the full-time caregiver for her husband with advanced cirrhosis.

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What they’re saying

“I'm scared right now.”

— Lori Kelley (KFF Health News)

“We're talking about saving money at the expense of people's lives. The work requirement is just a tool to do that.”

— Jane Tavares, Gerontology Researcher, University of Massachusetts Boston (KFF Health News)

“With me being his only caregiver, I can't go out and work away from home.”

— Paula Wallace (KFF Health News)

What’s next

Federal officials have yet to issue specific guidance on how to define the exemption for full-time caregivers, leaving uncertainty about how the new rules will be implemented.

The takeaway

The new Medicaid work requirements threaten to disrupt access to care for vulnerable populations, including middle-aged adults with chronic health conditions and family caregivers. Experts warn the rules could undermine people's ability to work by leaving health problems untreated, ultimately costing the healthcare system more in the long run.