Updated September 2026
What Are Medicaid Work Requirements?
Changes are coming to the Medicaid program, including MO HealthNet, in the form of work and community engagement requirements. These new policies, which Missouri must have in place by Jan. 1, 2027, make continued Medicaid eligibility contingent on participation in work or other qualifying activities.
These requirements apply to low-income adults ages 19-64 who qualify for Medicaid through the Adult Expansion Group (people who earn up to 138% of the Federal Poverty Level) or certain waiver programs.
Signed into law on July 4, 2025, the One Big Beautiful Bill Act (H.R. 1) is a federal budget law that introduced several changes to Medicaid, including these work requirements. Under the law, most eligible adults must complete 80 hours per month of one or more of the following:
- Paid employment
- Workforce training or a job search program
- Half-time enrollment in an educational program
- Community service
- A combination of these activities
Exemptions may apply to certain people, including children, seniors, pregnant and postpartum individuals, people who are medically frail, caregivers of young children or people with disabilities, and veterans with disabilities.
Starting in 2027, adults in this group will also need to verify their eligibility every six months instead of once a year.
What's New: How Missouri Will Verify Compliance
In September 2026, the Missouri Department of Social Services' Family Support Division (FSD) answered new questions about how the state will handle these requirements after a public town hall meeting. Two details matter most for Missourians right now:
- Self-attestation in 2027: For the first year the requirement is in effect, Missouri will let people simply state ("self-attest") that they meet a work requirement or qualify for an exemption, if the state can't already confirm it through existing records. You won't automatically be asked to submit paperwork on day one. Federal rules require states to move to stricter documentation requirements starting in 2028, so treat 2027 as a grace period, not a permanent pass.
- No short-term hardship exceptions: Federal law gives states the option to grant short-term hardship exceptions (for example, after a natural disaster or a personal emergency). Missouri has decided not to offer this option, so Missourians should plan to meet the requirements or document a qualifying exemption rather than count on a hardship waiver.
What Missourians Can Do Right Now
You don't need to submit hours or exemption paperwork today, but a few simple steps now can prevent a coverage gap later:
- Watch your mailbox. Between August and September 2026, DSS is mailing an "Adult Expansion Group Community Engagement Notice" in a colored envelope to more than 300,000 MO HealthNet participants who may be affected. Getting this notice does not mean your coverage is ending — it's informational. Open it, read it, and keep it for reference.
- Check that your household information is correct. The notice lists the household members DSS has on file. If anything is wrong, contact the Family Support Division to correct it.
- Update your contact information. Make sure your mailing address, phone number, and email on file with DSS are current at mydss.mo.gov, so you don't miss a future notice or deadline.
- Use the state's screening tool. Missouri's Community Engagement Requirements Screening Tool can give you an early sense of whether you're likely to be subject to the requirement or may qualify for an exemption.
- Bookmark the state's resource page. DSS keeps an updated H.R. 1 Participant Resources page with FAQs, a glossary of terms, and flyers in English and Spanish.
- Sign up for updates. Subscribe to the DSS email list and follow DSS on social media so you hear about changes as soon as they're announced.
What Does This Mean for Missouri?
Various reports estimate as many as 96,000 Missourians ages 19-64 could lose coverage related to complying with the new requirements and verifying their status twice a year.
Missouri also faces a complex and costly implementation process. The state must:
- Build systems to track work hours and exemptions
- Redesign eligibility and renewal processes
- Prepare for potential coverage losses and a rise in the uninsured
Key Dates to Know
- August-September 2026
- DSS mails Community Engagement Notices to potentially affected households
- Jan. 1, 2027
- Work and community engagement requirements take effect; self-attestation allowed
- Every 6 months starting 2027
- Adult Expansion Group members must renew eligibility and verify status
- 2028
- Self-attestation is phased out in favor of documentation, with some exceptions
What Comes Next?
Missouri must comply with these requirements by December 31, 2026, unless it demonstrates a good-faith effort and is granted a temporary extension (available through 2028).
Missouri Health Matters will continue to track this issue and update this page as the state releases more guidance. If you or someone you know may be affected, the steps above are the best way to be ready — not worried — when the requirements take effect.
Sources: Missouri Department of Social Services, H.R. 1 Participant Resources; Missouri Hospital Association Newsroom, "Family Support Division Releases New FAQs On Work Requirements," September 2026.