Medicaid Work Requirements Start by 1 January 2027: A Clinic's Patient-Outreach Playbook

This page is general information for clinics, checked against the federal sources listed below on 15 October 2026. It is not legal advice. Your state's rules, start date and reporting process control, and the federal rule is in active litigation. Talk to your counsel or your state Medicaid agency before you change how you handle eligibility. Nothing your clinic texts satisfies the work requirement for a patient.

The requirement applies to non-pregnant adults aged 19 to 64 who are eligible for or enrolled in the Medicaid adult (expansion) group or certain section 1115 demonstrations, and who are not entitled to or enrolled in Medicare. They show 80 hours a month of work, community service or a work program, half-time school, or a combination, or income equal to 80 hours at the federal minimum wage (CMS fact sheet).

Exempt groups include pregnant and postpartum people, parents or caregivers of a child 13 or under or of a disabled person, American Indians and Alaska Natives, veterans with a total disability rating, former foster youth, people in drug or alcohol treatment, and people who are medically frail. The rule defines medically frail as people who are blind or disabled, have a substance use disorder, have a disabling mental disorder, have a disability that significantly impairs one or more activities of daily living, or have a serious or complex medical condition.

States check at application and at renewal, and may check more often. Applicants show one to three months of activity before the month they apply, depending on the state. If a state can't verify compliance, it must send a notice and give the person 30 calendar days to show compliance or an exemption.

You can remind patients that rules are changing, tell them to open mail from the state, and point them to the state's reporting website or phone line. You can see patients who may qualify as medically frail or for another exemption, and document their conditions. CMS says states may accept documentation from many types of practitioners, including physicians, nurse practitioners, physician assistants, psychologists, counselors and clinical social workers. You can also host coverage-help hours with your enrollment staff.

You can't report hours for a patient through a text to your clinic, decide who is exempt, or promise that coverage will continue. Patients, or someone helping them, report to the state. The state decides. A reminder from you helps a patient act in time. It is not compliance.

Export the patient list from your EHR or practice management system as a CSV with MRN, phone, first name and any columns you need, such as state_portal_url or renewal_month. In BloomText, open Broadcast and follow Details, Recipients and Message. Pick Insecure text (can't contain PHI) for general notices and Secure text with link (can contain PHI) for anything about the patient's own coverage. See create a broadcast.

Upload up to 20,000 rows and map the columns (add recipients). Add variables with fallbacks, such as {{first_name | there}} (personalize messages). Send now or schedule a date, time and time zone. Set the time between messages so your front desk can keep up with replies, and pause if the phones get busy (send and track).

Numbers on your org's opt-out list aren't texted. In an Insecure broadcast they show as Failed with the reason. Replies arrive as private one-to-one conversations in your team inbox.

Broadcasts need the Patient SMS Add-on, membership in a team with an assigned phone number, and a verified account. BloomText verifies new accounts before their first broadcast. Broadcast runs in the BloomText web and desktop apps. The BAA is included on every plan, including the free plan.