Medicaid renewal used to be a once-a-year chore. For a lot of adults, it's about to come twice as often, and each time your state will also check whether you met the work rule. If your hours come from volunteering, that check is the one most likely to land on your kitchen table as a form.
The good news: renewal is predictable. If you know what it looks at, you can have your proof ready before the envelope shows up.
Who renews every 6 months
The 2025 budget law (Public Law 119-21, section 71107) says that for renewals "scheduled on or after the first day of the first quarter that begins after December 31, 2026," states must renew eligibility "once every 6 months" for adults in the Medicaid expansion group. In plain words: renewals scheduled on or after January 1, 2027.
That covers most people who also have to meet the 80-hour work rule. (New to the rule? Start with our guide to Medicaid work requirements and volunteering.) A few things to know:
- It's about your coverage group, not your hours. Even if you're exempt from the work rule, you'll likely still renew every 6 months, and your state will check whether you're still exempt.
- American Indians and Alaska Natives stay on 12-month renewals, CMS says.
- Some waiver programs stay on 12 months too. Your renewal notice will tell you your date.
What the Medicaid 6 month renewal work requirement checks
At each renewal, your state checks your income and the other usual things. If the work rule applies to you, it also checks your hours.
CMS's Medicaid community engagement interim final rule (42 CFR 435.556) says that at renewal, you must show you met the rule for "1 or more months ... whether or not consecutive" in the time since your last eligibility decision. Your state picks how many months.
| What | The federal rule | What states chose (KFF, April 2026) |
|---|---|---|
| How many months at renewal | At least 1, set by your state | 34 states: 1 month. Arkansas: 3 months. |
| Do the months need to be in a row? | No | |
| How often hours are checked | At renewal, or more often if your state chooses | Most: every 6 months. Indiana and New Hampshire: every quarter. |
Here's the catch most people miss. CMS points out that most states take 60 to 90 days to finish a renewal. So on a 6-month schedule, your state may start checking when you've only been in your coverage period for about 3 months. If you plan to meet the rule late in the period, you might be too late. Aim to hit 80 hours early in each 6-month stretch, and every month if you can.
States that check more often
The federal rule lets a state check your hours between renewals. As of April 2026, KFF reported that Indiana and New Hampshire "will verify compliance with work requirements quarterly," and that both plan to check that people meet the rule every month between renewals, because their state laws require it. Plans can change, so check your state on our state-by-state table.
How renewal works, step by step
- Your state checks its own data first. This is called an ex parte renewal. The rule says your state must renew you "without requiring information from the individual" if it can, using things like payroll records and other agencies' files. If it can, you get a notice. You don't have to sign and return it unless something on it is wrong.
- If it can't, you get a renewal form. The form comes filled in with what the state already knows. You get at least 30 days from the date on the form to answer. You can send it back by any way your state takes applications, usually online, by phone, by mail, or in person. The state can't make you come in for an interview.
- If the form doesn't settle your hours, you get a noncompliance notice. That gives you 30 more days to show you met the rule or that it doesn't apply to you. Your coverage keeps going while you answer. Our guide to answering a Medicaid work rule notice walks through it.
Volunteering almost never shows up in state data. State staff told KFF they "probably would not be able to get information for most volunteer activities." So if you volunteer, plan on step 2.
What changes on January 1, 2028
Right now, the federal rule lets states accept your word for some things. Until January 1, 2028, a state "may require documentation or accept other information" when its data can't confirm your hours.
Starting January 1, 2028, the rule tightens. When your state can't confirm your hours from its own data, it "must require documentation whenever documentation is reasonably available." For a volunteer, that usually means a signed letter or form from the organization.
There's a safety valve. Your state must accept other information when no documents reasonably exist, and it "may not deny or terminate eligibility solely because the individual is unable to produce documentation where none exists." But don't count on that. A signed record is much easier.
A monthly routine that takes ten minutes
Don't wait for the renewal letter. Six months of hours is hard to rebuild from memory. Here's a simple routine:
- Log every shift the day you do it. Date, start and end time, what you did, and who supervised. Our free volunteer hours log has the columns.
- On the last day of the month, add it up. Did you reach 80 hours across work, school, and volunteering?
- In the first week of the next month, get it signed. Ask the coordinator to sign that month's total, with a phone or email someone can call.
- Keep it in one place. A folder, an envelope, or photos on your phone. One page per month.
- Put your renewal month on your calendar, and a reminder 3 months before it.
- Open every letter from Medicaid. Answer even if you're not sure what it means.
If you have a month where you can't meet the rule because of a hospital stay, a disaster, or something similar, write that down too. Some states give short-term hardship exceptions, and the notice has to tell you if yours does.
If you miss the deadline
It isn't over. If your coverage ends because you didn't send the form or the proof, the federal rule gives you at least 90 days to send it in and have your state reconsider without a whole new application. You can also apply again with no waiting period. Read what to do if you lost Medicaid over the work rules.
Where Verified Hours fits
Most people can meet the renewal check with a paper log and a signed monthly letter. Verified Hours does the same thing on your phone: you log shifts, your nonprofit confirms them, and each month you get a signed letter with a QR code your caseworker can scan. It's free for you and the nonprofit. Whatever you use, the point is the same: have each month's proof done before anyone asks for it.
Renewals every 6 months add one more thing to keep track of. Pick a day each month to total and sign your hours, and you'll be ready whenever your state checks.