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CHARLOTTE, N.C. (WBTV) – Low-income North Carolinians will soon have to work at least 80 hours a month to keep their Medicaid coverage under sweeping new federal rules<\/a>.<\/p>\n Starting Jan. 1, 2027, most adults ages 19 to 64 will be subject to a new \u201cwork and community engagement requirement<\/a>\u201d to get or keep their Medicaid coverage.<\/p>\n Under the requirement, Medicaid enrollees must log at least 80 hours a month of work, school, job training or community service. A household can also satisfy the rule by earning at least $580 a month before taxes — which is roughly equivalent to working 80 hours at the federal minimum wage.<\/p>\n Before the work rules take effect, several other major Medicaid restrictions<\/a> will roll out in the coming months, including tighter eligibility rules for noncitizens, twice-yearly renewals and shortened retroactive coverage.<\/p>\n The changes stem from H.R. 1, a major federal budget law dubbed the \u201cOne Big Beautiful Bill<\/a>,\u201d which President Donald Trump signed into law in July 2025.<\/p>\n An estimated 7.8 million people nationwide will lose health insurance over the next decade as a result of the controversial budget law, according to the nonpartisan Congressional Budget Office<\/a>.<\/p>\n Use the WBTV guide below to break down the upcoming rule changes and what they mean for your coverage:<\/p>\n WBTV Investigation: How did a convicted felon, Charlotte activist bill Medicaid for millions?<\/a><\/p>\n What are the Medicaid work requirements?<\/p>\n The \u201cwork and community engagement requirement<\/a>\u201d is the most far-reaching restriction to Medicaid enrollees in recent decades.<\/p>\n Starting Jan. 1, 2027, most adults ages 19 to 64 will be required to complete at least 80 hours a month of work, school, job training or community service. Households can also satisfy the requirement if they earn at least $580 a month before taxes.<\/p>\n Enrollees who do not meet the work requirement or qualify for an exemption may lose their Medicaid benefits, officials said.<\/p>\n Who is exempt from the work requirements?<\/p>\n State officials said many people do not need to meet the work requirement, including people with disabilities, parents with young children and those with SNAP benefits.<\/p>\n You may be exempt from the work requirement if you are:<\/p>\n Outside the target age: Younger than 19 or older than 64.A parent or caregiver: Caring for a child under 14 or someone with a disability.Pregnant or postpartum: Currently pregnant or gave birth in the past 12 months.Living with a disability or medical condition: Receiving SSI, SSDI, or Medicare; a veteran rated 100% disabled; or experiencing a disabling physical, mental, or developmental condition.In treatment: Enrolled in a substance use or alcohol rehabilitation program.Already meeting other work rules: Complying with SNAP (FNS) or Work First (TANF) work requirements.In or recently released from custody: Currently incarcerated or released within the last 90 days.In foster care: Currently in foster care or a former foster youth up to age 26.Native American or Alaska Native: Eligible for Indian Health Services.<\/p>\n Individuals with complex medical conditions may also qualify for an exemption even if their condition is not explicitly listed, according to the North Carolina Department of Health and Human Services<\/a>.<\/p>\n Read: Charlotte dermatologist speaking out against Medicare payment cuts to doctors<\/a><\/p>\n How often do I have to renew my Medicaid coverage?<\/p>\n State officials<\/a> said the work mandate will take effect alongside a faster renewal schedule. Medicaid beneficiaries will have to renew coverage every six months instead of once a year. <\/p>\n Individuals seeking renewal will also be required to meet the \u201cwork and community engagement requirement\u201d for at least three of the six months leading up to each recertification.<\/p>\n For example, an enrollee renewing in July 2027 would need to have met the work requirement for any three months between January and June of that year.<\/p>\n If someone loses their Medicaid coverage and is unable to appeal the decision, they will need to meet the work requirement for three consecutive months before reapplying.<\/p>\n What to know:<\/p>\n Tighter renewal timeline: You must renew every six months\u2014instead of annually\u2014meeting work rules in at least three of those months. Dropped from Medicaid: If you lose your coverage, you must meet the work requirement for three consecutive months before reapplying.<\/p>\n State officials said enrollees can contact the North Carolina Medicaid Ombudsman<\/a>, an independent office that helps recipients understand Medicaid coverage, notices and bills.<\/p>\n The following organizations may also be able to help:<\/p>\n Read: Family shares concerns about North Carolina Medicaid cuts<\/a><\/p>\n Will Medicaid cover medical expenses before I enroll?<\/p>\n Retroactive coverage: Also starting Jan. 1, 2027, the window of time Medicaid will retroactively pay for health care costs before an application is submitted will shrink from the current three months.<\/p>\n Those who qualify for retroactive coverage include:<\/p>\n Most adults ages 19 through 64 who do not have a disability: Medicaid will cover up to one month of health care costs incurred before an application is submitted.Children, adults 65 and older, and people with disabilities: Medicaid will cover up to two months of health care costs incurred before an application is submitted.<\/p>\n For anyone who applies by Dec. 31, 2026, Medicaid will still cover approved costs for up to three months prior to the application date.<\/p>\n What if I am a noncitizen?<\/p>\n Starting Oct. 1, 2026, officials said<\/a> many people who are not U.S. citizens could lose their Medicaid coverage.<\/p>\n Noncitizens can get or keep Medicaid if they belong to the following groups:<\/p>\n Lawful permanent residents with green cards (most green card holders must wait five years before they qualify)Children lawfully residing in the U.S. who are younger than 19Women lawfully residing in the U.S. who are pregnant or who gave birth within the past 12 monthsCubans or Haitians with entrant statusCitizens of the Federated States of Micronesia, the Republic of the Marshall Islands or the Republic of Palau<\/p>\n People lawfully present in the U.S. without permanent residency status may no longer qualify for Medicaid, including refugees and people granted asylum.<\/p>\n Individuals with temporary lawful status — such as those on student visas and work visas — were already ineligible for public health benefits like Medicaid and SNAP food assistance.<\/p>\n Emergency Medicaid: Some noncitizens may still receive coverage through Emergency Medicaid, a limited program that covers the cost of emergency care regardless of immigration status for \u201ctrue medical emergencies,\u201d provided patients meet income and other eligibility criteria. 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