Answer
If I lose Medicaid because of the work requirements, can I get a marketplace subsidy?
Answer
Usually not. Starting by January 1, 2027, adults 19 to 64 covered through Medicaid expansion must show 80 hours a month of work, community service, a work program, or half-time school, unless they qualify for an exemption. If you are denied or dropped from Medicaid only because you didn't meet that requirement, you also can't get a premium tax credit for a marketplace plan. If you lose Medicaid for another reason, such as higher income, you can usually get a subsidy through a 60-day special enrollment period.
The rule comes from the 2025 federal budget law. States must start Medicaid work requirements by January 1, 2027. Some can start earlier, and states that show a good-faith effort can get extra time, up to the end of 2028.
- Who has to meet them: adults 19 to 64 covered through Medicaid expansion. Exemptions include parents and caregivers of children 13 and under, people who are pregnant or postpartum, and people who are medically frail, among others. Your state Medicaid agency decides who is exempt.
- The marketplace catch: being denied or dropped from Medicaid for not meeting the requirement also blocks premium tax credits, so a full-price plan is usually the only marketplace option.
- Other reasons don't carry the penalty: if you lose Medicaid because your income rose above the limit, or for another reason, you get a 60-day special enrollment period and can get a subsidy if you qualify.
- What to do: report your hours or ask about an exemption before your state's deadline, and keep proof of work, school, or volunteering.
Filed under