The Work and Community Engagement Requirement

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Starting January 1, 2027, most adults ages 19 through 64 will need to work, go to school, volunteer or make a certain amount of money each month to keep Medicaid. This is called the work and community engagement requirement.

If you do not meet the requirement, you may lose your Medicaid benefits, including coverage to go to doctors or dentists, get prescriptions or receive mental health care.

Step 1: Do you need to meet the work and community engagement requirement to keep your Medicaid?

If you answer yes to any question below, you do not need to meet the new requirement. You may have to provide documents to support your answer.

Read the entire list. There are a lot of people who do not need to meet the requirement.

  • Are you younger than age 19?
  • Are you older than age 64?
  • Are you a parent, guardian, caretaker relative or family caregiver of a dependent child under age 14?
  • Are you a parent, guardian, caretaker relative or family caregiver of a person with a disability?
  • Are you pregnant or were you pregnant in the last 12 months?
  • Do you qualify for Medicare?
  • Do you get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)?
  • Are you a veteran with a total disability rating (100%)?
  • Has NC Medicaid already determined that you have a disability?
  • Does someone in your household get Supplemental Nutrition Assistance Program (SNAP), also called Food and Nutrition Services (FNS), and you already meet its work rules?
  • Do you already meet the work rules for Work First (TANF)?
  • Are you currently in foster care, or are a former foster care youth up to age 26?
  • Are you American Indian, Alaska Native or eligible for Indian Health Services (IHS)?
  • Are you in jail or prison right now?
  • Were you released from jail or prison in the last 3 months?
  • Are you in a drug addiction or alcohol treatment and rehabilitation program?
  • Are you blind or disabled, as defined by the Social Security Act?
  • Do you have a substance use disorder?
  • Do you have a disabling mental disorder?
  • Do you have a physical, intellectual or developmental disability that impairs your ability to perform 1 or more activities of daily living?

If you have a serious and complex medical condition, even if it is different from those listed here, it is possible you may not have to meet the requirement. NC Medicaid is still working out what kinds of situations will qualify. If you think your situation might qualify, keep proof and tell your local Department of Social Services.

If you answered yes to any of the above, you do not need to meet the requirement.

You should not have to report your work, school or volunteer activities. Your Medicaid should continue like it does today.

You should tell your local DSS about your situation. Collect any papers, medical records, official documents or other proof that you fall into one of these categories. Submit them to your local DSS as soon as possible, so they can confirm that the requirement does not apply to you.

Answer any letter right away. Your local DSS may ask for more information to confirm that you do not need to meet the requirement.

Starting January 1, 2027, you will renew every 6 months instead of once a year. If you need to provide more information, you may get a notice when it is time to renew.

If you did not answer yes to any of the above:

You will have to meet the requirement. Continue to Step 2.

If you are not sure:

Call your local DSS to ask about your situation. Do not guess.

Step 2: Know how to meet the requirement

There are two ways to meet the requirement. You only need to do one.

Earn $580 each month

This $580 each month can include money from other people in your household, such as your husband or wife.

Some money that is not from a job also counts, like unemployment benefits.

Or do 80 hours of approved activities each month

This is about 20 hours a week. You can do a mix of these activities. They just have to add up to 80 hours.

  • Work at a job or for yourself
  • Be in a work training program
  • Some kinds of unpaid work
  • Go to school at least half-time
  • Volunteer or do community service
Tab/Accordion Items

Money you make from a job, and some money that is not from a job, counts. Money earned by some other people in your household can also count.

You can count money earned from:

  • Jobs and employment
  • Unemployment benefits
  • Alimony, but only from a divorce finalized before 2019
  • Rental income, if you rent out property
  • Interest, dividends or capital gains

You can count money earned by these people:

  • Yourself
  • Your spouse
  • Your children under age 21, including stepchildren
  • Any other person on the same federal income tax return (including your children over age 21 who are claimed on your tax return).

You may not count money earned from:

  • Child support
  • Veterans' benefits
  • Workers' compensation
  • TANF/Work First
  • SNAP 
  • Gifts or inheritances

If you are a seasonal worker, your local DSS will look at your average monthly income over the last 6 months. It must be at least $580.

Work. A paid job or working for yourself.

In-kind work. Work where you are paid with something other than money. For example, a property manager who gets free rent in exchange for working can meet the 80 hours this way.

Volunteering. The activity must be part of a structured program run by a non-profit or public organization, for the direct benefit of the community. Court-ordered community service counts.

Unpaid work. This is different from volunteering, because it can benefit a private company or a person. It includes internships and a trial work period. It also includes unpaid caregiving, if you are a family caregiver who does not already meet an exception or exclusion.

Job search. A supervised job search, a structured employment program, job search training and job searches you do to meet unemployment insurance rules all count. However, searching for a job must be less than half of your 80 hours. So, a job search alone is not enough. For example, 40 hours of a job search plus 40 hours of volunteering meets the requirement. But 80 hours of searching for jobs does not.

School. College, career and technical education, high school and GED programs all count. You must attend at least half-time. Half-time is usually 6 credit hours. Your school decides whether you count as enrolled, so ask your registrar or financial aid office if you are not sure. School breaks still count. You do not stop meeting the requirement over the summer.

To find out whether a particular activity counts, contact your local DSS.

Step 3: Keep proof

Collect and save any pay stubs, timesheets, volunteer logs, school records or similar papers that prove you are meeting the requirement. 

Start keeping papers now. You will need them in 2027. Your local Department of Social Services may ask to see them.

Step 4: Be ready when you renew

You need to meet the requirement for only 3 of the 6 months before your recertification. 

Recertification is when your NC Medicaid is renewed, which happens every 6 months. (American Indians, Alaska Natives and other members eligible for Indian Health Services (IHS) renew once a year.) 

For example: if your recertification happens in July 2027, you would need to work 80 hours or earn $580 for any 3 months between January 2027 and June 2027.

If you lose your Medicaid

You will get a letter. It will explain why, and it will tell you how to appeal if you disagree. You usually have 60 days from the date on the letter. How to appeal a Medicaid decision

You can reapply for Medicaid at any time, but the work requirement rule is stricter when you apply or reapply. You must meet the work and community engagement requirement for 3 months in a row, in the 3 months before you apply. That means if you apply in April 2027, you will need to meet the requirement in January, February and March 2027. 

For free help with a notice or a bill, call the NC Medicaid Ombudsman at 1-877-201-3750. The Ombudsman is independent of your local DSS.

These organizations may also be able to help:

What to do now

  1. Check that your local DSS has your address and phone number. Your local DSS will write to you about these changes. If your address is wrong, you could lose your Medicaid without knowing why. Update online or find your local DSS.
  2. Answer any letter right away. Letters from your local DSS usually have a deadline. Missing a deadline is a common reason people lose their Medicaid.
  3. Start keeping proof. Keep pay stubs, school records, volunteer logs, benefit letters or medical records.
  4. Get an enhanced ePASS account if you do not have one.  You need an enhanced account to upload any documents you may need to share to keep your Medicaid coverage.
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This page was last modified on 08/31/2026