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Beginning January 1, 2027, more than 500,000 adults enrolled in the Healthy Michigan Plan — Michigan’s Medicaid expansion program — will face new federal community engagement requirements. While often called “work requirements,” enrollees can qualify through education, job training, community service, or income, with exemptions for certain groups.

Key Findings

• Most Medicaid enrollees already work or may qualify for an exemption. Seventy percent of non-disabled Michigan Medicaid enrollees ages 19–64 are working, while many others report caregiving, illness or disability, or school attendance as reasons for not working. All of these reasons qualify for an exemption or are permissible forms of engagement.
• Reporting requirements could put eligible people at risk of losing coverage. Strict documentation requirements will place additional administrative burden on enrollees and states, increasing the likelihood of coverage losses.
• Past work requirements reduced coverage without increasing employment. In Arkansas, about 18,000 people lost coverage, largely because of reporting and administrative barriers, while research found no impact on employment.
• Michigan could see significant Medicaid coverage losses. The state initially projected that 40,000 people could lose coverage, though that estimate predates more restrictive federal guidance on medical frailty.

Read the full brief to learn how the new requirements will work, who is exempt, what previous work requirements tell us, and what the changes could mean for Medicaid coverage in Michigan.

Read the Brief