The letter says your Medicaid is ending, or already ended, because you didn't meet the work requirement. Maybe you never saw the first notice. Maybe you sent your volunteer letter and it didn't count. Maybe you were in the hospital that month. Whatever happened, it's scary to be without coverage, especially if you take medicine every day.
Here's the part the letter doesn't make loud enough: losing Medicaid over the work rules is not permanent, and you have several ways back. Some of them are fast.
What losing Medicaid over work rules looks like
Under the federal rule, it doesn't happen all at once. There are steps, and each one gives you a chance.
- Your state can't confirm your hours or an exemption from its own data or your renewal form.
- You get a noncompliance notice. It gives you 30 days to show you met the rule or that it doesn't apply to you. The notice counts as received 5 days after the date printed on it. Your coverage keeps going during those 30 days. (Our guide to answering a Medicaid work rule notice covers this step.)
- Your state checks every other way you might qualify for Medicaid before it ends your coverage.
- You get a notice of the decision at least 10 days before your coverage ends. It must say why, and it must explain your hearing rights.
- Your coverage ends no later than the end of the month after the month your 30 days ran out.
If you're reading this at step 4, you still have Medicaid. Move fast, because the hearing section below matters most for you.
Option 1: Send the missing proof (the 90-day window)
In Nebraska, the first state to enforce the rule, KFF found that of the 533 people who lost coverage at renewal from July to mid-August 2026, "92% did not respond to verification compliance requests." Only 8% were found to have actually fallen short. So for most people, the fix is paperwork, not hours.
The federal rule has a path for exactly that. If you were covered through Medicaid expansion and lost it "for failure to submit information requested in a notice of noncompliance," your state must reconsider if you send that information within 90 days after your coverage ended, "or a longer period elected by the State, without requiring a new application." (That's 42 CFR 435.558(f) and 435.916(a)(3)(iii).)
There's one wrinkle. CMS says the state treats what you send as an application, dated the day you send it. So your state looks at the month (or up to 3 months, depending on your state) right before the day you turn it in. Our page on the Medicaid look-back month explains how that works.
What to do:
- Find the noncompliance notice and see exactly what it asked for.
- Get it: a signed letter from your volunteer coordinator, pay stubs, a school schedule, or proof of an exemption.
- Send it the way your state takes applications (online, phone, mail, or in person) and keep a copy.
- Call a few days later to make sure it's in your file, and write down who you talked to.
Option 2: Ask for a fair hearing
A fair hearing is your right to have someone outside the office that made the decision look at it again. You don't need a lawyer, and it's free. Ask for one if you think the state got it wrong: you did meet the rule, you sent proof and they lost it, you're exempt, or you never got the notice.
| What federal rules say | |
|---|---|
| Deadline to ask | Your state sets it, up to 90 days from the date the notice was mailed. Check your notice. |
| Keep coverage while you wait | Ask before the date of action on your notice. In most cases your coverage continues until the decision. |
| Asked a few days late? | If you ask within 10 days after the date of action, your state may turn your coverage back on. |
| How long it takes | Usually a decision within 90 days of your request. |
| Urgent health need | You can ask for an expedited hearing if waiting could put your life or health at risk. |
| If you lose | Your state may try to recover the cost of care you got while waiting. |
These come from the federal Medicaid fair hearing rules at 42 CFR 431.211, 431.221, 431.224, 431.230, 431.231, and 431.244. Your state's notice has its own dates. Go by those.
Say it plainly, by phone or in writing: "I want a fair hearing, and I want my Medicaid to continue while I wait." Write down the date and the name of the person you spoke to.
Option 3: Reapply, with no waiting period
You can apply again any time. The federal rule says your state "must not impose any restriction" on your ability to reapply or get coverage because you were denied or disenrolled over the work rule. CMS adds that states "must not impose a 'waiting period' or 'lock-out period.'"
When you reapply, you'll need to show you met the rule (or are exempt) for the month before you apply, or up to 3 months in some states. If you're short right now, it may make sense to get 80 hours in this month and apply at the start of next month. Our volunteer hours letter template has everything a caseworker looks for.
Hardship exceptions and exemptions you may have missed
Medicaid doesn't have "good cause" the way SNAP does. Instead, states can choose to offer short-term hardship exceptions, which count a month as met. The federal rule allows them for:
- A stay in a hospital, nursing facility, or similar inpatient care.
- Living in a county with a federally declared emergency or disaster.
- Living in a county with high unemployment.
- You or a dependent having to travel outside your community for a long time to get care for a serious medical condition.
Not every state offers these. If yours does, the noncompliance notice must say so. Nebraska offers all four, according to KFF.
Also look again at the exemption list. Parents and caregivers of a child 13 or under, people who are medically frail, people who are pregnant or postpartum, former foster youth under 26, and several other groups are left out of the rule entirely. In Nebraska, KFF found exclusions were the most common way people kept coverage at renewal. Read who is exempt from Medicaid work requirements, and if one might fit, tell your state. Only your state can decide if you qualify.
What about a Marketplace plan?
Usually not with help paying for it. The law says that if you'd have Medicaid except for not meeting the work rule, you're treated as having Medicaid for premium tax credit purposes. That means you generally can't get a subsidized Marketplace plan for those months. Getting Medicaid back is usually the better path.
Get free legal help
Legal aid lawyers handle Medicaid cases every day, often for free. Find an office at LawHelp.org, which lists nonprofit legal aid by state. In Nebraska, Legal Aid of Nebraska tells people to contact them "if you receive a termination notice." Bring your notices, your proof, and your notes. If your hours were turned down rather than missing, our guide to what to do when volunteer hours are rejected walks through the common fixes.
Where Verified Hours fits
Most people who lose coverage over these rules didn't fail the hours. They didn't get the right paper to the right office in time. Verified Hours keeps a signed monthly record of your volunteer hours, confirmed by your nonprofit, with a QR code a caseworker can scan. It's free for you and the nonprofit. A signed paper letter for each month works too. What matters is having it ready before the next notice.
Losing coverage is a setback, not the end. Pick the option that fits, do it this week, and call legal aid if you get stuck.