Medicaid members living in the Bronx will be exempt from the new federal work requirements when they take effect on January 1, 2027 — because the borough meets the law’s high-unemployment threshold, the New York State Department of Health has confirmed.
The Bronx is currently the only county in New York that qualifies for the carve-out, according to the department, which has already notified the federal Centers for Medicare & Medicaid Services (CMS) of its plan. Roughly 200,000 residents who would otherwise have been subject to the rules will be spared, state health officials said during an October 7 briefing.
How the Exemption Works
Under the federal law (HR 1), Medicaid members are exempt from the work requirements if they live in a county with an unemployment rate at or above 8%, or 1.5 times the national rate — whichever is lower. The Bronx clears that bar; no other New York county currently does.
For everyone else, the requirements are significant: adults ages 19 to 64 covered through Medicaid expansion will need to show they are working, in school, in job training, or volunteering for at least 80 hours a month — or earning at least $580 a month — to keep their coverage, unless they qualify for an exemption.
Why This Matters Beyond the Bronx
New York’s move lands in the middle of a much larger fight. Five Democratic governors — of Oregon, California, Maine, New Mexico, and Virginia — wrote to HHS Secretary Robert F. Kennedy Jr. on October 1 asking him to delay the January 1, 2027 compliance date, arguing states cannot build the verification systems, notices, and staff training in the fewer than 100 days remaining.
The governors warned that rushed implementation would cause eligible people to lose coverage over paperwork — citing federal estimates that roughly half of expected coverage losses will come from reporting failures, not ineligibility. They pointed to Arkansas’s 2018 experiment, where more than 95% of the people who lost coverage were later found to have met the requirement or qualified for an exemption.
The administration has not signaled a delay. HHS and CMS leaders say the requirements promote dignity and connection to work, and that states can use the change to modernize their Medicaid systems.
Other States Are Drawing Their Own Lines
New York is not the only state making consequential choices about how strict to be:
- Indiana estimates 58,000 people on its Healthy Indiana Plan are currently not in compliance with the coming rules — about 12% of the plan’s members at risk when enforcement begins.
- Missouri has declined to adopt optional federal “short-term hardship” exemptions for people who are hospitalized, traveling for medical care, or living through disasters — saying it will handle those cases through existing mandatory exemption pathways instead.
The result is a patchwork: where you live increasingly determines how the same federal law treats you.
What Enrollees Should Do Now
Whether or not you live in an exempt county, the most protective steps are the same:
- Update your contact information with your state Medicaid agency so you actually receive notices.
- Read every letter from the agency — most coverage losses in early-implementing states have come from unanswered verification requests.
- Keep proof of work, school, or volunteer hours starting now.
- Check whether you qualify for an exemption — parents of young children, pregnant women, people with disabilities, former foster youth, and tribal members are among those carved out.
For a plain-English walkthrough of the 80-hour rule, who is exempt, and how to document your hours, see the Medicaid work-requirements guide at MedicaidWorkCheck.
Frequently Asked Questions
Is the Bronx really exempt from Medicaid work requirements?
Yes. The New York State Department of Health confirmed the Bronx meets the federal law’s high-unemployment threshold, and the state has notified CMS it will apply the exemption there.
Who has to meet the Medicaid work requirements?
Generally, adults ages 19 to 64 covered through Medicaid expansion who are not exempt. They must show 80 hours a month of work, school, volunteering, or a work program — or earn at least $580 a month.
When do the requirements start?
January 1, 2027. Some states are using a three-month look-back, meaning compliance may effectively need to start in the fall of 2026.
Could the deadline be delayed?
Five governors have asked HHS to delay it, but no delay has been granted. Plan as if January 1, 2027 stands.
What if I move out of the Bronx?
The exemption is tied to where you live. If you move to a county that does not meet the unemployment threshold, the requirements would apply to you.