Starting January 1, 2027, most adults with Medicaid will need to show that they are working, going to school, completing job training, or doing community service to keep their Medicaid coverage.
How to Meet the New Medicaid Community Engagement Requirement
| If the requirement applies to you, you may meet it by: | What this means |
|---|---|
| Working | Work at least 80 hours per month |
| Volunteering/community service | Complete at least 80 hours per month |
| Job training | Participate in an approved program |
| School | Attend an educational program at least half-time |
| Combination | Combine qualifying activities to reach 80 hours |
| Income | Earn at least the equivalent of 80 hours at the federal minimum wage |
Do you have a story about access to eye care?
What does “medically frail” mean?
“Medically frail” is a term used in the Medicaid requirements. It does not simply mean that you have a medical diagnosis.
To be considered “medically frail”, a person must have a qualifying condition and that condition must significantly affect the person’s ability to meet the Medicaid community engagement requirement. These are the five categories:
- Blindness or disability
- Substance use disorder
- Disabling mental disorder
- Physical, intellectual or developmental disability that significantly affects activities of daily living
- Serious or complex medical condition
Am I “medically frail” if I am blind or have significant vision loss?
People who meet the federal definition of blindness or disability may be excluded from the Medicaid community engagement requirement.
However, not every person with vision loss or an eye disease will automatically qualify. The requirements use specific federal definitions, and your state Medicaid agency will determine whether a person meets an exclusion.
If you have significant vision loss, blindness, or another health condition that makes it difficult to participate in “community engagement activities”, ask your state Medicaid agency whether you qualify for an exclusion.
You may not have to prove everything yourself.
Your state Medicaid program may already have information about your health conditions from your medical records, Medicaid claims, or other health information.
If the state does not have enough information, they may ask you for additional information or documentation. This is why it is important to make sure your address and contact information are up-to-date with your state Medicaid program.
Five Steps to Get Ready for the 2027 Medicaid Changes
What if I receive a notice saying I may lose Medicaid?
If Medicaid tells you that you may lose your coverage:
- Read the notice carefully.
- Find the deadline.
- Contact your state Medicaid office.
- Ask why you are being asked to provide information.
- Tell Medicaid if you believe you qualify for an exclusion.
- Provide requested information or documentation by the deadline.
- Ask about your appeal rights if you disagree with the decision.
If your state Medicaid Office cannot confirm that you met the requirement, it must provide notice and an opportunity for you to demonstrate that you have met the requirement or that the requirement does not apply to you.
Medicaid requirements and procedures can vary by state
Your state Medicaid agency will tell you whether the new requirements apply to you, what information you need to provide, and when you need to provide it.
Losing Medicaid doesn’t necessarily mean losing health coverage
If you no longer qualify for Medicaid, you may be able to get health insurance through the Health Insurance Marketplace.
Do not wait until you need medical or eye care to look for new coverage
If you receive a notice that your Medicaid coverage is ending, find out when your coverage ends and what other coverage options are available. This is particularly important because a gap in coverage can mean delayed eye examinations, delayed treatment, or difficulty obtaining medications and eyeglasses.
Additional Resources
Medicaid Eligibility Changes – Primary federal consumer resource that explains the upcoming changes and provides state-specific information.
Medicaid Community Engagement Fact Sheets
Easy-to-understand federal overview of who is affected, the 80-hour requirement, exemptions and verification.
Find Your State Medicaid Agency
The most important source for an individual’s specific deadline, reporting process and eligibility status.
A useful backup resource if someone loses Medicaid and needs to explore other health insurance options.
The Centers for Medicare and Medicaid Services
Also directs consumers to HealthCare.gov when Medicaid coverage ends.
Prevent Blindness:
Understanding Your Eye care Benefits
Information about other sources of eye care coverage.
Information about eye examinations, eye care providers and preparing for an eye appointment.
Why this matters for your eye health
Medicaid helps many people access important health and eye care. Changes in Medicaid eligibility could affect whether some people continue to have health coverage.
If you have vision loss, blindness, diabetes, diabetic retinopathy or another eye condition, it is important to understand how the new Medicaid requirements may apply to you.
Don’t assume that you are required to meet the work or community engagement requirement—and don’t assume that you are automatically exempt. Check with your state Medicaid program to understand your individual situation.
More about how eye care is covered by each type of insurance.
This page was published for the first time in October 2026. Medicaid requirements and state implementation procedures may change. Check with your state Medicaid agency for the most current information about your coverage.
