Medicaid Work Requirements for Parents and Caregivers
Most parents of young children, and people who care for someone with a disability, do not have to meet the new 80-hour Medicaid rule. Here is who counts and what changes when a child turns 14.
Short answer: If you are a parent, guardian, or caretaker relative of a child 13 or younger, or you regularly care for a person with a disability, you do not have to meet the work requirement. If your youngest child is 14 or older and you get Medicaid through the adult expansion group, the rule can apply to you from January 1, 2027 (earlier in a few states), unless another exemption fits.
First: does the rule cover you at all?
The rule only covers adults 19 to 64 in the Medicaid adult "expansion" group (plus Georgia Pathways and Wisconsin BadgerCare Plus adults without children at home). Many low-income parents get Medicaid through a different group for parents and caretaker relatives. People in that group are not covered by the rule at all (42 CFR 435.553(a)(3)). Your Medicaid notice or your state agency can tell you which group you are in.
The exemption in the law
Federal law excludes anyone "who is the parent, guardian, caretaker relative, or family caregiver ... of a dependent child 13 years of age and under or a disabled individual" (Social Security Act sec. 1902(xx)(9)(A)(ii)(III)). The CMS rule (42 CFR 435.554) defines each word:
| Term | What the CMS rule says |
|---|---|
| Dependent child | A child 13 or younger who relies on someone for care |
| Parent | A legal mother or father, including by adoption, who gives the child some level of care |
| Guardian | An adult appointed by a court to care for the child or person with a disability |
| Caretaker relative | A relative who lives with the child and has primary responsibility for their care, such as a grandparent, aunt, uncle, brother, sister, cousin, niece, nephew, or step-relative |
| Disabled individual | Anyone who meets the Americans with Disabilities Act definition. They do not need to get disability benefits or Medicaid. |
| Family caregiver | An adult with a significant relationship to the child or person with a disability who helps them with a broad range of care |
A family caregiver qualifies if one of these is true:
- You live with the child or person with a disability and help them regularly (not just now and then).
- You are a relative who helps them regularly, even if you live apart.
- You are not a relative and do not live with them, but you give at least 80 hours of care a month.
More than one adult in the same home can qualify for the same child.
When your youngest child turns 14
The parent exemption ends when no child in your care is 13 or younger, unless you also care for a person with a disability (this can be your teen, if they have a disability). Any month in which you were exempt for even part of the month counts as meeting the rule. After that, you will need to meet the rule in the months your state checks, usually at your next renewal. Starting in 2027, adults in the expansion group renew every 6 months.
Examples
| Situation | Exempt? |
|---|---|
| Single mom of an 8-year-old | Yes, as a parent |
| Grandmother raising her 10-year-old grandson at home | Yes, as a caretaker relative |
| Dad whose only child is 15 and has no disability | No, unless another exemption fits |
| Adult son who helps his mother with a disability several times a week across town | Yes, as a family caregiver (relative, regular help) |
| Neighbor who gives a friend with a disability about 90 hours of care a month | Yes, as a family caregiver (non-relative, 80+ hours) |
| Neighbor who helps a friend with a disability about 10 hours a month | No, a non-relative needs 80+ hours |
What proof is usually needed
Your state must check the records it already has first, such as the household members and ages on your Medicaid case. For caregiving, the state may ask screening questions or for a short statement about the care you give. The CMS rule says the state may not require the name of the person with a disability you care for, and may not deny the exemption just because you decline to name them. It can ask for enough information to show that the person meets the disability definition.
Until January 1, 2028, states may accept your statement when their records don't settle it. From 2028, they must ask for documents when documents are reasonably available. A non-relative caregiver should keep a simple log of care hours.
What to do next
- Use the free checker to see if the rule applies to you and which exemptions may fit.
- Make sure every child in your home is listed on your Medicaid case, and report changes such as a new child or a new caregiving role.
- If your youngest child will turn 14 soon, start keeping records of work, school, or volunteer hours, and add them up with the 80-hour calculator.
- Find your state guide for start dates, how to report, and who to call.
- 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
Do parents have to meet the Medicaid work requirement?
Not if you are the parent, guardian, or caretaker relative of a child 13 or younger. Parents whose children are all 14 or older can be covered by the rule if they get Medicaid through the adult expansion group and no other exemption fits.
Does my child have to live with me?
For a parent, not always. CMS defines a parent as a legal mother or father who gives the child some level of care. A caretaker relative must live with the child. A family caregiver who does not live with the child must be a relative who helps regularly, or must give at least 80 hours of care a month.
My child is 15 and has a disability. Am I exempt?
Yes, if your child meets the Americans with Disabilities Act definition of disability and you care for them. The age limit of 13 applies only to children without a disability.
Are foster parents exempt?
CMS did not name foster parents. A foster parent who lives with a child 13 or younger and cares for them regularly appears to fit the "family caregiver" definition. Tell your state about the child and ask it to confirm.
Can both parents in my home be exempt?
Yes. The CMS rule says more than one parent, guardian, caretaker relative, or family caregiver in the same home can qualify.