Medicaid Work Requirements in High-Unemployment Areas
A county with very high unemployment can be excused from the 80-hour rule, but it is not automatic. Your state has to ask, and CMS has to agree.
Short answer: Not automatically. States may choose to excuse people who live in a county where unemployment is at or above 8%, or 1.5 times the national rate if that is lower. The state must ask CMS for each county, and CMS must approve. If it does, the exception is applied automatically, without you asking. Nebraska got the first approval we found, for Dawson County, in July 2026.
The rule in the law
This is one of the optional "short-term hardship" exceptions (sec. 1902(xx)(3)(B)). A state may treat you as meeting the rule for a month if you live in a county, or similar local area, that has an unemployment rate at or above the lesser of:
- 8 percent, or
- 1.5 times the national unemployment rate
For example, if the national rate were 4%, the bar would be 6%, because 6% is lower than 8%.
How it works
- States choose. A state does not have to offer short-term hardship exceptions, and even a state that does is not required to ask for the unemployment one.
- CMS must approve each county. The state sends CMS a request naming the counties and showing the rate. CMS uses Bureau of Labor Statistics data, and may accept newer state labor department data when a big layoff has not shown up yet (42 CFR 435.555(d)(3)).
- It is automatic for you. The CMS rule says a state may not make you ask for this exception.
Example: Dawson County, Nebraska
After the Tyson beef plant in Lexington closed, Nebraska asked CMS for this exception. CMS approved it in July 2026. Nebraska DHHS said anyone who has lived in Dawson County at any point since February 1, 2026 is exempt automatically, until the county's unemployment rate falls below 8% or 1.5 times the national rate, whichever is lower. See the Nebraska guide.
Disasters work the same way
States may also excuse people in a county with a presidential emergency or disaster declaration. That one does not need a separate CMS approval and is also applied automatically. See all short-term hardship exceptions.
What CMS has not published
As of October 31, 2026, we did not find a CMS list of approved counties. Check your state guide or ask your state Medicaid agency whether it has asked for any.
What to do next
- Ask your state Medicaid agency whether it offers short-term hardship exceptions and whether your county is approved.
- Even if your county is not approved, check other ways to meet the rule, including volunteering and job training.
- Add up your month with the 80-hour calculator.
- Use the free checker to see if the rule applies to you and which exemptions may fit.
- Got a notice? You have at least 30 days to answer, and you can ask for a fair hearing. See what to do about a notice.
Frequently asked questions
My county has high unemployment. Am I exempt from Medicaid work requirements?
Only if your state offers this exception, asks CMS to approve your county, and CMS agrees. If it does, the exception is applied for you automatically.
What unemployment rate qualifies?
At or above 8%, or 1.5 times the national unemployment rate, whichever is lower.
Do I have to apply for this exception?
No. The CMS rule says states may not require a request for the unemployment or disaster exceptions.
Which counties are approved?
The first approval we found is Dawson County, Nebraska (July 2026). CMS has not published a full list that we could find, so ask your state.
Sources
- Public Law 119-21 (H.R. 1), sec. 71119: community engagement requirement (GovInfo)
- CMS interim final rule, Medicaid community engagement requirement, 91 FR 33348 (June 3, 2026)
- CMS-2454-IFC, official PDF (GovInfo)
- U.S. Bureau of Labor Statistics: Local Area Unemployment Statistics
- Nebraska DHHS: Dawson County approved for temporary exemption from Medicaid work requirements (July 17, 2026)
- KNOP News 2: Dawson County residents get Medicaid work requirement exemption after Tyson plant closure (July 17, 2026)