The envelope says it's from your Medicaid office. Inside, a letter says the state couldn't confirm you met the work requirement, and that your coverage could end. Your stomach drops. Maybe you did the hours and nobody asked for proof. Maybe you have a toddler and assumed the rule didn't apply to you.
Here's the most important thing on this page: this notice is not a final decision. It's a chance to fix the record, and you have 30 days to do it.
What a Medicaid noncompliance notice means
Under the new 80-hour rule, your state checks its own data first, like wage records and SNAP files. When that data can't confirm you met the rule or that you're excluded from it, the state must send you a notice of noncompliance. Volunteers get these a lot, because volunteer hours almost never show up in state records.
CMS, the federal Medicaid agency, says plainly that the notice "serves a similar purpose to that of a request for information" and "does not mean the State has made a final determination." The rules come from the CMS interim final rule on Medicaid community engagement, at 42 CFR 435.558.
You might get the notice when you apply, at renewal (sometimes in the same envelope as your renewal form), or at an extra check between renewals if your state does those.
Don't ignore it: what happened in Nebraska
Nebraska started its Medicaid work rule on May 1, 2026, ahead of the federal deadline. When KFF looked at Nebraska's early numbers, the pattern was clear:
| Lost out for not responding | Actually found not to meet the rule | |
|---|---|---|
| Denied applications (557) | 84% | 16% |
| People who lost coverage at renewal (533) | 92% | 8% |
Most people who lost out never answered. In Nebraska, KFF says the notice comes with a declaration form "that must be returned within 30 days," which people can use to say they met a qualifying activity or an exclusion. Other states will use their own forms.
So answer, even if you're not sure what to say. A phone call is better than silence.
What the notice must tell you
The federal rule lists what every noncompliance notice must include in clear statements. Check yours for each one:
- Which month or months your state is checking. (Our guide to the Medicaid look-back month explains how states pick them.)
- How to show you met the rule, through work, volunteering, school, a job program, or earnings.
- How to show you should be counted as meeting it, through an exception like a recent hospital stay or being under 19 during that month.
- How to show the rule doesn't apply to you, because you're in an excluded group.
- Your deadline.
- How to send your information, using any of the ways you can apply for Medicaid.
- What happens if you don't respond, including the effect on marketplace tax credits.
- How to reapply if you're denied or lose coverage.
- Short-term hardship exceptions, if your state offers them.
If anything on this list is missing or confusing, call and ask. You have a right to understand it.
When your 30 days start and end
You get 30 calendar days to respond. The clock starts when you receive the notice, and the rule says when that is: the notice "is considered to be received 5 days after the date on the notice, unless the applicant or beneficiary shows that he or she did not receive the notice within the 5-day period."
Here's how that plays out. Say the notice is dated March 2. It's treated as received March 7. Your 30 days run from there into early April. In practice, that's about 35 days from the date printed on the letter.
But don't do the math yourself and plan around the last day. The notice has to print your deadline. Go by that date, and aim to send your proof in the first week or two.
If the notice reached you late, say so. CMS gives examples of when that happens: you were in the hospital, your mail was on hold, or you were away from home.
Your coverage keeps going while you respond
If you're already enrolled, your state must keep your Medicaid going during the 30 days, and after that until it formally decides you're not eligible. Keep going to appointments and filling prescriptions.
If you're applying, the notice can slow your application down. CMS gave states extra time past the usual 45-day limit when they're waiting on your 30-day window. The sooner you answer, the sooner you get a decision.
What to send
You have two ways to answer. Pick the one that fits, or use both if you're not sure.
Show you met the rule
For each month the notice names, send proof of 80 hours (any mix of work, community service, school, or a job program), or earnings that meet the rule.
For volunteer hours, send a letter from the organization for each month. CMS lists what helps: the program, the dates and hours, what you did, the organization's name and address, and "a point of contact at the organization who can confirm the hours completed." Our free volunteer hours letter template has every one of those.
Other proof: pay stubs, a school schedule or transcript, or a letter from your job program.
Show the rule doesn't apply to you
If you fit an excluded group, like caring for a child 13 or under, being pregnant, being medically frail, or being a veteran rated 100 percent disabled, say so and send what you have. Our guide to who is exempt from Medicaid work requirements lists every group and the proof CMS mentions. Only your state can decide whether you qualify.
Before January 1, 2028, your state may ask for documents or accept other information. Starting January 1, 2028, it must ask for documents when they're reasonably available. Either way, it can't deny you just because documents don't exist.
Your 30-day checklist
- Day 1: Find the deadline and the months. Circle both on the notice.
- Day 1: Call your Medicaid office. Use the script below. Write down the date, the worker's name, and what they said.
- Days 1 to 7: Gather proof for each month named, or for your exclusion. Ask your volunteer coordinator for signed letters now. Coordinators can take a week.
- Days 7 to 14: Send it the way the notice says. Online is fastest if you can. If you mail it, keep a copy and ask the post office for proof of mailing.
- Two or three days later: Call to confirm it's in your file.
- Before the deadline: Follow up again if you haven't heard. Ask, "Is anything else missing?"
- Keep everything: the notice, copies of what you sent, and your call notes.
What to say on the phone
"Hi, I got a notice dated [date] saying you couldn't verify the Medicaid work requirement. My name is [name] and my case number is [number]. Which months do you need proof for? I volunteer at [organization] and can get a signed letter with my hours. Will that work, and what's the best way to send it? What's my exact deadline?"
If you think you're excluded:
"I think the work requirement doesn't apply to me because [reason, like 'I care for my 6-year-old']. What do you need from me to confirm that?"
If you have a disability that makes the paperwork hard, you can ask for help or a reasonable change in how the rule is applied to you.
What happens after the 30 days
If you sent enough proof, your state records you as meeting the rule (or excluded), and your coverage continues or your application moves forward.
If you didn't, here's what the federal rule requires, in order:
- Your state must check every other way you might qualify for Medicaid before saying no.
- It must send a written notice with the specific reasons and your fair hearing rights. For people losing coverage, that notice must come at least 10 days before the date of action.
- Coverage can end no later than the end of the month after the month your 30 days ran out.
- Your state must check whether you qualify for other coverage. But the 2025 law says someone who would have had Medicaid except for not meeting the work rule can't get marketplace premium tax credits. So other affordable coverage may be hard to find.
You can ask for a fair hearing
If you think the decision is wrong, ask for a fair hearing. Ask before the date of action on your notice to keep your coverage while you wait, in most cases. Your state sets the deadline, but under the federal Medicaid fair hearing rules it can't be more than 90 days from when the notice was mailed. Our guide to what to do when your hours are rejected walks through hearings step by step.
You can reapply right away
Your state can't make you wait. CMS says states "must not impose a 'waiting period' or 'lock-out period'" after a denial or loss of coverage under this rule. And if you were on expansion Medicaid and lost it for not sending the requested information, sending it within 90 days after your coverage ends (some states allow longer) means your state must look at your case again without a full new application. It treats the date you send it as your application date, so the look-back months shift with it. Our guide to getting Medicaid back after losing it over work rules covers this in depth.
Free legal aid can help at any step. Find a nonprofit legal aid office near you at LawHelp.org.
Where Verified Hours fits
Most noncompliance notices for volunteers come down to one thing: the state had no record of your hours. Verified Hours gives you a signed monthly record from the place you volunteer, with a QR code your caseworker can scan to check it, so you can answer a notice the same day. It's free for volunteers and nonprofits. A signed letter from your coordinator works too, and most people will answer their notice that way.
Open the notice, circle the deadline, and make one phone call today. Thirty days is enough time if you start now.