New federal Medicaid work requirements are coming, but they do not apply to everyone receiving Medicaid. Adults age 65 and older are outside the population subject to the new federal Medicaid community engagement requirement, and federal law also excludes numerous younger adults who are disabled, medically frail, or providing qualifying care to a disabled individual.

The more complicated question involves people under age 65 who receive Medicaid-funded home care, Home and Community-Based Services (HCBS), personal care, or other long-term services and supports.

For those individuals, the answer depends heavily on which Medicaid eligibility category provides their coverage and whether they fall within one of the federal exclusions.

This distinction is critical because “Medicaid” is not one single eligibility program. Medicaid covers many different populations under different financial, medical, and categorical eligibility rules.

Quick Answer: Do Medicaid Work Requirements Apply to Long-Term Care Medicaid?

For most elderly nursing home Medicaid recipients, no. The new federal work requirement applies to certain adults ages 19 through 64 who are not entitled to or enrolled in Medicare and who receive Medicaid through specified eligibility categories.

People who are medically frail, disabled, or qualifying family caregivers may also be excluded from the requirement.

Receiving Medicaid home care or HCBS does not, by itself, answer whether the work requirement applies. The person’s underlying Medicaid eligibility category and the federal exclusions must be examined.

What Are the New Medicaid Work Requirements for 2027?

The Centers for Medicare & Medicaid Services (CMS) issued its Medicaid Community Engagement Requirement Interim Final Rule in June 2026.

The regulations became effective July 31, 2026, and states must implement the federal community engagement requirement no later than January 1, 2027. States may implement the requirement earlier.

For Medicaid recipients who are actually subject to the requirement, qualifying community engagement can include:

• Employment

• Community service

• Participation in qualifying work programs

• Enrollment in an educational program at least half-time

• A combination of qualifying activities

The basic federal standard is 80 hours per month, although the rule also permits compliance through qualifying monthly earnings.

But the key phrase is “who are actually subject to the requirement.”

Millions of Medicaid beneficiaries are outside the population covered by the new rule.

Who Is Subject to the New Medicaid Work Requirement?

According to CMS guidance on the Medicaid community engagement requirement, the federal requirement applies to certain non-pregnant adults ages 19 through 64 who:

• Are not entitled to or enrolled in Medicare; and

• Are eligible for or enrolled in the Medicaid adult group or certain Section 1115 demonstration populations providing minimum essential coverage.

This means the requirement is not a universal Medicaid work requirement.

Someone receiving Medicaid because of age, disability, institutional eligibility, or another Medicaid eligibility category may be governed by completely different rules.

Do Medicaid Work Requirements Apply to People Age 65 and Older?

No.

The federal Medicaid community engagement requirement applies to certain adults ages 19 through 64.

A person age 65 or older is outside that age range.

That means an 82-year-old receiving nursing home Medicaid does not have to work, volunteer, attend school, or perform another community engagement activity for 80 hours per month to maintain Medicaid eligibility.

The same age limitation applies to an older adult receiving Medicaid-funded long-term care at home.

Do Medicaid Work Requirements Apply to Nursing Home Medicaid?

The new federal rule does not impose an 80-hour work requirement on nursing home Medicaid recipients.

Nursing home Medicaid is part of Medicaid’s long-term care system —  not simply another name for Medicaid expansion health insurance.

This distinction is often lost in news reports that discuss “Medicaid recipients” as though everyone receiving Medicaid qualifies under the same rules.

They do not.

Medicaid can provide:

• Health insurance for low-income adults

• Health coverage for children

• Pregnancy-related Medicaid

• Medicaid for people who are blind or disabled

• Nursing home Medicaid

• Home and Community-Based Services

• Personal care and attendant services

• Medicaid waiver services

• Other long-term services and supports

The Medicaid eligibility category matters.

Do Medicaid Work Requirements Apply to HCBS Waivers?

Receiving Home and Community-Based Services does not automatically mean that a person is subject to the Medicaid work requirement.

HCBS recipients may qualify for Medicaid through several different eligibility pathways.

Some people receiving Medicaid-funded home care already qualify through an aged, blind, disabled, institutional-level-of-care, or other Medicaid category outside the population targeted by the work requirement.

Other individuals under age 65 may receive coverage through a Medicaid category potentially affected by the new rule.

For those individuals, the federal exclusions become extremely important.

This is why no one receiving Medicaid home care should assume either that the new work requirement applies or that it does not apply without first identifying the person’s actual Medicaid eligibility category.

What Is the Medicaid Medically Frail Exemption?

One of the most important protections for people with significant long-term care needs is the federal exclusion for individuals who are medically frail or otherwise have special medical needs. Under the October 29, 2026 decision in Commonwealth of Massachusetts v. Oz, people who meet one of Congress’s five express medical categories cannot be required to prove additionally that their condition significantly impairs their ability to satisfy the community engagement requirement.

The rule addresses individuals with conditions including:

• Blindness or disability

• A disabling mental disorder

• A physical, intellectual, or developmental disability that significantly impairs the ability to perform one or more activities of daily living

• A serious or complex medical condition meeting the rule’s requirements

This exclusion is particularly significant for people under age 65 who require long-term care services because of conditions such as Parkinson’s disease, multiple sclerosis, traumatic brain injury, significant physical disability, developmental disability, or other serious medical conditions.

The relevant question is whether the individual meets a statutory medically frail category, supported by the required verification. For the physical, intellectual, or developmental disability category, Congress specified a significant impairment in one or more activities of daily living—not an inability to satisfy the monthly work requirement. The court invalidated CMS’s additional work-related impairment test.

Does Someone Need Social Security Disability to Be Exempt?

No.

A Social Security disability determination can be highly relevant, but it is not the only path to exclusion. The statute separately protects people in other qualifying medically frail categories, without requiring a completed Social Security disability determination or the additional work-related impairment test invalidated on October 29, 2026.

The medically frail provisions also address qualifying physical, intellectual, developmental, mental, serious, and complex medical conditions.

This matters because someone can have substantial care needs long before receiving a final Social Security disability determination.

A younger adult who needs extensive help bathing, dressing, transferring, toileting, eating, managing medications, or functioning safely may have substantial long-term care needs even if the Social Security Administration has not yet completed a disability determination.

What Do Activities of Daily Living Have to Do with Medicaid Work Requirements?

Activities of daily living, commonly called ADLs, can be important evidence of the severity and functional effect of a disability or medical condition.

ADLs include basic personal-care functions such as:

• Bathing

• Dressing

• Toileting

• Transferring

• Eating

• Other essential daily functions

Functional limitations involving ADLs are already central to many Medicaid long-term care eligibility determinations.

For individuals qualifying through the statutory category involving physical, intellectual, or developmental disabilities, documentation of significant impairment in at least one activity of daily living is important. Other listed medically frail categories have their own statutory criteria. The October 29, 2026 decision makes clear that a person within one of those categories cannot also be required to show that their condition prevents compliance with the 80-hour community engagement requirement.

Are Family Caregivers Exempt from Medicaid Work Requirements?

Qualifying family caregivers can be excluded from the federal Medicaid community engagement requirement.

CMS identifies parents, guardians, caretaker relatives, and family caregivers of certain children or disabled individuals among the excluded populations.

This recognizes an obvious reality of America’s long-term care system: family caregivers are already working.

A daughter who helps a disabled parent bathe, dress, transfer, prepare meals, manage medications, attend medical appointments, and remain safely at home is performing essential caregiving work regardless of whether she receives a paycheck.

Without family caregivers, many older adults and disabled individuals would require substantially more paid home care, assisted living care, or nursing home care.

What Happens if Medicaid Cannot Verify That Someone Is Exempt?

This is where the new Medicaid work requirement may create the greatest practical problems for people who truly qualify for an exclusion.

Being legally excluded from the work requirement and having the Medicaid eligibility system correctly recognize the exclusion are not the same thing.

CMS requires states to identify which individuals are subject to the requirement and which individuals qualify for exclusions or exceptions.

If the state cannot verify compliance, the state must provide notice and give the individual 30 calendar days to demonstrate compliance or establish that the requirement does not apply.

This creates a potentially dangerous administrative problem for people who have:

• Dementia

• Cognitive impairment

• Serious physical disabilities

• Neurological illnesses

• Mental illness

• Communication difficulties

• Limited access to electronic systems

• No family member actively monitoring Medicaid correspondence

A person can be fully entitled to Medicaid and still lose coverage temporarily because a notice was missed, evidence was not submitted, or the eligibility system failed to recognize an exclusion.

Why Medicaid Administrative Errors Are Especially Dangerous for Home Care Recipients

For someone receiving ordinary health insurance through Medicaid, a temporary eligibility problem can interrupt access to physicians, prescriptions, and medical treatment.

For someone dependent on Medicaid-funded long-term care, the consequences can be even more immediate.

A Medicaid home care recipient may depend on an aide for:

• Getting out of bed

• Bathing

• Dressing

• Toileting

• Preparing meals

• Medication assistance

• Transferring between a bed and wheelchair

• Preventing falls

• Remaining safely at home

Interrupt those services and a paperwork problem can quickly become a health and safety crisis.

A spouse or adult child may suddenly have to stop working.

A caregiver may become overwhelmed.

A fall or medication error may occur.

A hospitalization may follow.

And a person who could have continued living safely at home may ultimately wind up in a nursing home.

Why Medicaid Home Care Is So Important to Long-Term Care Planning

Home and Community-Based Services are designed to allow many people who would otherwise need institutional care to receive services in their homes or other community settings.

For many families, Medicaid-funded home care is precisely what prevents or delays nursing home placement.

That makes continuity of Medicaid eligibility essential.

We have written extensively about Medicaid benefits and at-home care and the complicated rules that determine when Medicaid will pay for services outside a nursing facility.

People who want to remain at home must understand that Medicaid home care programs have their own medical, financial, and programmatic eligibility requirements.

Can Medicaid Pay for Long-Term Care at Home?

Yes.

Medicaid can pay for substantial long-term care services in the home through HCBS waivers, state-plan services, personal care programs, and other Medicaid authorities.

The exact services, financial eligibility rules, functional eligibility requirements, and program structure vary by jurisdiction.

For families in Virginia, Maryland, and Washington, DC, understanding which Medicaid home care program applies is often just as important as understanding the Medicaid financial eligibility rules.

Does Medicare Pay for Long-Term Care Instead?

No. Medicare does not pay for long-term care.

This is one of the most important distinctions in Elder Law and long-term care planning.

Medicare explains that it does not pay for long-term care.

Medicare can cover certain medical, rehabilitative, skilled nursing, and home health services when its coverage requirements are satisfied, but that is not the same as paying for ongoing custodial long-term care.

For Americans who cannot privately pay indefinitely for nursing home care or extensive home care, Medicaid remains the principal government program that pays for long-term care.

Will Medicaid Work Requirements Affect Virginia?

Yes, the federal community engagement rules can affect certain Virginia Medicaid beneficiaries beginning no later than 2027.

But the rules do not suddenly convert Virginia nursing home Medicaid or every Virginia Medicaid home care program into a work-requirement program.

The first question is always: what Medicaid eligibility category is the person actually using?

The second question is whether the person qualifies for a federal exclusion or exception.

For individuals receiving Virginia Medicaid long-term care services, those questions should be answered before assuming that a headline about “Medicaid work requirements” applies to them.

Will Medicaid Work Requirements Affect Maryland?

Certain Maryland Medicaid beneficiaries can be affected, but the rule does not apply to every person receiving Maryland Medicaid.

Maryland operates several Medicaid eligibility categories and long-term care programs, including institutional Medicaid and Medicaid-funded home and community-based care.

A Maryland Medicaid beneficiary’s age, Medicare enrollment, eligibility category, disability status, medical condition, and caregiving status can all affect whether the federal community engagement requirement applies.

Will Medicaid Work Requirements Affect Washington, DC?

Yes, certain DC Medicaid beneficiaries fall within the population covered by the new federal requirement.

But DC Medicaid also provides long-term care through eligibility pathways and programs that must be analyzed separately.

People receiving Medicaid-funded long-term care in Washington, DC, should not assume that the new rule applies simply because they receive Medicaid.

What Should Families Receiving Medicaid Long-Term Care Do Now?

Do not assume that the Medicaid work requirement applies merely because someone receives Medicaid.

Instead:

• Determine the beneficiary’s exact Medicaid eligibility category

• Determine whether the person is within the 19-through-64 population covered by the federal rule

• Determine whether the person is enrolled in Medicare

• Determine whether a disability or medically frail exclusion applies

• Determine whether a family caregiver exclusion applies

• Keep copies of medical and functional documentation

• Review every Medicaid notice immediately

• Challenge an incorrect Medicaid determination before essential long-term care services are interrupted

For families already dealing with a long-term care crisis, this is not an area for guesswork.

Frequently Asked Questions About Medicaid Work Requirements and Long-Term Care

Do Medicaid work requirements apply to seniors?

No. The new federal community engagement requirement applies to certain adults ages 19 through 64. Someone age 65 or older is outside that age range.

Do Medicaid work requirements apply to nursing home residents?

The federal rule does not impose an 80-hour work requirement on elderly nursing home Medicaid recipients. A younger nursing facility resident may also qualify for an exclusion or exception depending on the person’s Medicaid eligibility category and circumstances.

Do Medicaid work requirements apply to nursing home Medicaid?

Not as a blanket rule. Medicaid nursing home coverage and Medicaid expansion health coverage are different eligibility pathways. The individual’s Medicaid eligibility category controls the analysis.

Do Medicaid work requirements apply to HCBS waiver recipients?

Not automatically. Receiving Home and Community-Based Services does not itself determine whether the federal work requirement applies. The recipient’s underlying Medicaid eligibility category and any applicable exclusion must be examined.

Are disabled adults exempt from Medicaid work requirements?

Federal law excludes specified disabled and medically frail individuals who satisfy the applicable requirements. The exact basis for exclusion must be documented and recognized by the state Medicaid agency.

What is the Medicaid medically frail exemption?

The rule excludes qualifying individuals who are medically frail or otherwise have special medical needs that significantly impair their ability to comply with the community engagement requirement.

Does a medical diagnosis automatically exempt someone from Medicaid work requirements?

No. The medical condition must satisfy the applicable federal standard. Functional impairment and the effect of the condition on the person’s ability to meet the community engagement requirement are critical.

Does someone need Social Security Disability to qualify for the medically frail exclusion?

No. Social Security Disability is not the only basis for exclusion. The federal rule addresses other qualifying physical, intellectual, developmental, mental, serious, and complex medical conditions.

Can family caregivers be exempt from Medicaid work requirements?

Yes. Qualifying parents, guardians, caretaker relatives, and family caregivers of certain children or disabled individuals are among the populations excluded under the federal rule.

How many hours must someone work under the Medicaid work requirement?

An applicable individual can satisfy the basic requirement through at least 80 hours per month of qualifying work, community service, work-program participation, a qualifying combination of activities, or other methods permitted by the federal rule.

What happens if Medicaid says someone did not meet the work requirement?

If the state cannot verify compliance, the federal rule requires notice and a 30-calendar-day opportunity for the person to establish compliance or demonstrate that the requirement does not apply.

Can Medicaid pay for care at home?

Yes. Medicaid can pay for home and community-based long-term care through HCBS waivers, personal care programs, state-plan services, and other Medicaid programs.

Does Medicare pay for long-term care?

No. Medicare does not pay for ongoing custodial long-term care. Medicaid is the principal government program that pays for long-term nursing home care and many forms of long-term care at home.

Can Medicaid pay family members to provide care?

Some Medicaid home care programs allow payment to certain family caregivers, depending on the program, jurisdiction, relationship, and applicable Medicaid rules.

Are Medicaid work requirements the same in Virginia, Maryland, and DC?

The federal framework applies across affected jurisdictions, but implementation, Medicaid eligibility pathways, administrative procedures, and long-term care programs differ among Virginia, Maryland, and Washington, DC.

Medicaid Planning Is About Much More Than Filing an Application

Medicaid eligibility was enormously complicated before Congress added community engagement requirements.

For someone who needs long-term care, Medicaid planning can involve:

• Protecting a lifetime of savings from long-term care expenses

• Determining the correct Medicaid eligibility pathway

• Qualifying for nursing home Medicaid

• Qualifying for Medicaid home care

• Navigating HCBS waiver rules

• Establishing medical and functional eligibility

• Documenting asset transfers

• Correcting Medicaid eligibility errors

• Appealing adverse Medicaid decisions

• Ensuring that eligibility actually results in access to needed care

Farr Law Firm focuses extensively on Medicaid Asset Protection and Life Care Planning for families throughout Virginia, Maryland, and Washington, DC.

For families who have time to plan before a long-term care crisis, a properly designed Living Trust Plus® Medicaid Asset Protection Trust can also be an important component of long-term care asset protection planning.

If you or a family member needs nursing home care, Medicaid-funded home care, or advance planning to protect assets from the catastrophic expenses of long-term care, contact Farr Law Firm.