Parents, guardians, and caretaker relatives caring for a child 13 years old or younger are fully exempt from the new federal Medicaid work requirements taking effect in 2027. That means if you are the primary caregiver of a dependent child in that age range, you do not need to work, volunteer, or attend school to keep your Medicaid coverage. But you may still need to report your caregiver status to your state Medicaid agency, and failing to do so could put your coverage at risk.
This guide explains exactly how the caregiver exemption works, who qualifies, what the new requirements look like for those who do not qualify, and what steps you should take now to protect your coverage.
What Are the New Medicaid Work Requirements?
Under the One Big Beautiful Bill Act (H.R. 1), signed into law in 2025, states must require most adults aged 19 to 64 in the Medicaid expansion population to complete at least 80 hours per month of qualifying activities to keep their Medicaid coverage. States must implement this requirement by January 1, 2027, though some states may begin earlier through approved waivers.
The 80-hour monthly requirement can be met through a combination of:
- Employment (part-time or full-time)
- Participation in a job training or workforce development program
- Enrollment in an educational program (at least half-time)
- Community service activities
- A combination of any of the above
Individuals who do not meet these requirements and do not qualify for an exemption can lose their Medicaid coverage. This is a significant change for the roughly 20 million adults in expansion Medicaid who were not previously subject to any work-related conditions.
The Child Under 13 Caregiver Exemption
Federal law explicitly exempts parents, guardians, caretaker relatives, and family caregivers of a dependent child 13 years of age and under from the work requirement entirely. This is a full exemption, not a partial reduction in required hours.
The exemption language in the law covers:
- Parents living with a child 13 or younger
- Legal guardians of a child 13 or younger
- Caretaker relatives such as grandparents, aunts, uncles, or siblings caring for a child 13 or younger
- Family caregivers providing ongoing care for a dependent child 13 or younger
A child qualifies as a dependent for this exemption if they live with you and rely on you for their daily care. The child does not need to be your biological child. Foster children, grandchildren, nieces and nephews, and other family members in your care can all qualify your household for this exemption.
What About Children Age 14 and Older?
The federal exemption specifically covers children age 13 and under. If your youngest child is 14 or older, you do not automatically qualify for the caregiver exemption based on that child's age alone. You would need to meet the 80-hour requirement or qualify for a different exemption category.
However, if your teenage child has a disability that substantially impairs their ability to perform daily tasks, a separate exemption applies. Parents and caregivers of disabled individuals of any age also qualify for the full caregiver exemption.
Full List of Medicaid Work Requirement Exemptions
The caregiver exemption is one of nine categories that exempt individuals from the 80-hour requirement entirely.
| Exemption Category | Who Qualifies |
|---|
| Caregiver of child under 13 | Parents, guardians, caretaker relatives of children age 13 and under |
| Caregiver of disabled individual | Parents or caregivers of a person with a qualifying disability |
| Medically frail | Individuals who are blind, disabled, have serious mental illness, substance use disorders, or complex medical conditions |
| Pregnant or postpartum | Pregnant individuals and those within 12 months of giving birth |
| Foster care youth | Current or former foster care recipients under age 26 |
| American Indians and Alaska Natives | Individuals eligible for Indian Health Service |
| Disabled veterans | Veterans with total disability ratings |
| Current work program participants | Individuals already meeting TANF or SNAP work requirements |
| Recently incarcerated | Individuals within 3 months of release from incarceration |
States may also grant temporary exemptions for circumstances such as hospitalization, federally declared disaster areas, counties with unemployment rates above 8 percent, or when individuals must travel extensively for ongoing medical treatment.
How to Claim Your Caregiver Exemption
The exemption is not always applied automatically. Whether your state automatically identifies your exempt status depends on how your state has set up its Medicaid eligibility systems.
Here is what you should do to make sure your exemption is recognized:
Step 1: Check whether your state has automatic exemptions.
Some states can use data already in their Medicaid eligibility system to identify parents and caregivers of children under 13 without requiring additional paperwork. Contact your state Medicaid agency or check their website to learn whether automatic exemptions are available.
Step 2: Report your caregiver status on applications and renewals.
Even in states with automatic identification, you should indicate your caregiver status on any Medicaid application or renewal form. Look for questions about household composition, dependent children, and caregiver status.
Step 3: Document your household.
Keep records that show you live with and provide care for a child 13 or younger. Documents such as birth certificates, custody orders, school enrollment records, or medical records listing you as the child's caregiver can all help establish your exempt status.
Step 4: Respond to outreach from your state Medicaid agency.
Federal law requires states to conduct member outreach between June 30 and August 31, 2026, by mail and through at least one additional method such as phone, text, or email. If you receive any communication about work requirements, respond promptly and confirm your exempt status.
Step 5: Complete your annual renewal.
Work requirement status is typically reviewed at renewal. Make sure your renewal form accurately reflects your current household, including all children in your care.
When Implementation Starts
States are required to implement Medicaid work requirements no later than January 1, 2027. A handful of states, including Nebraska, began implementation earlier in 2026 through Section 1115 demonstration waivers.
States that demonstrate good-faith implementation efforts may receive an extension through December 31, 2028. The Centers for Medicare and Medicaid Services (CMS) issued initial guidance on December 8, 2025, and is expected to release additional guidance through June 1, 2026.
If you live in a state that began early implementation, your state Medicaid agency should have notified you directly. If you have not received any notice and are unsure whether your state has started, contact your state agency or visit their website.
Who Is Affected If They Do NOT Have an Exemption
If you are an adult aged 19 to 64 in the Medicaid expansion population and you do not qualify for any exemption, you must complete at least 80 hours per month of qualifying activities. Falling short of this requirement in a given month can result in losing your Medicaid coverage.
To be clear about who this affects: the work requirement applies to the Medicaid expansion population, meaning adults who gained Medicaid coverage after states expanded eligibility under the Affordable Care Act. Adults in traditional Medicaid categories, such as those receiving Supplemental Security Income, those who are elderly, or those enrolled through pregnancy, are generally not affected.
States Where This Takes Effect
All 40 states plus Washington D.C. that have expanded Medicaid are required to implement work requirements by January 1, 2027. The ten non-expansion states are not directly affected by this particular requirement, though their Medicaid populations are generally more restricted to begin with.
If you are in a non-expansion state, this requirement does not apply to your coverage. If you are in an expansion state, your state will implement these rules on or before January 1, 2027.
Common Questions About the Child Under 13 Exemption
Does the exemption apply if I share caregiving duties with a partner?
Yes. The exemption applies to the individual who is the caregiver, not necessarily the only adult in the household. If you are listed as the parent or caretaker and your child lives with you, you qualify for the exemption regardless of whether another adult in the household also provides care.
What if my child turns 14 during the year?
When your youngest qualifying child turns 14, you would no longer qualify for the child under 13 exemption. At that point, you would need to meet the 80-hour monthly requirement unless you qualify for another exemption category. Your state should notify you at renewal when your exemption status changes.
Does the exemption cover grandparents raising grandchildren?
Yes. The law specifically includes caretaker relatives, not just parents. A grandparent, aunt, uncle, or older sibling who is the primary caregiver for a child 13 or younger qualifies for the same exemption as a biological parent.
Does the child need to be on Medicaid too?
No. The exemption is based on your role as a caregiver, not the child's insurance status. Even if your child is covered by a different health plan, your caregiver status can still exempt you from the work requirement.
What if I am a single parent with a child under 13 and a child over 13?
As long as at least one child in your care is 13 or younger, you qualify for the caregiver exemption. The age of your other children does not affect your exempt status.
What if I care for a child with a disability who is older than 13?
A separate exemption covers caregivers of disabled individuals regardless of age. If your child is 14 or older but has a disability that significantly impairs their ability to perform daily tasks, you likely qualify for the caregiver-of-disabled-individual exemption.
What to Do Right Now
Even though the federal deadline is January 1, 2027, the time to act is now. Here is a short checklist:
- Verify you are enrolled in Medicaid and your household information is current.
- Confirm your state has your children's information on file, including ages and your relationship to them.
- Watch for outreach from your state Medicaid agency in summer 2026.
- Respond immediately to any notices, and explicitly state your caregiver status.
- At your next renewal, confirm the exemption is reflected in your record.
Not sure if you qualify for Medicaid or another benefits program? Use the free eligibility screener at BenefitsUSA.org to check your options in minutes without creating an account.
Frequently Asked Questions
Who qualifies for the Medicaid work requirement child under 13 exemption?
Parents, legal guardians, caretaker relatives, and family caregivers who live with a dependent child aged 13 or younger are fully exempt from the 80-hour monthly work requirement. This includes biological parents, adoptive parents, grandparents, aunts, uncles, and any other relative serving as the primary caregiver.
Do I have to prove my child lives with me to get the exemption?
States are required to give applicants and enrollees the opportunity to report their caregiver status on applications and renewal forms. In some cases, states can use existing data to verify household composition. In other cases, you may need to provide supporting documents such as a birth certificate, custody order, or school records listing your address.
When do Medicaid work requirements start?
States must implement the requirements by January 1, 2027. Some states began earlier through approved Section 1115 waivers. CMS is issuing final guidance through June 2026.
What counts as qualifying activity for the 80-hour requirement?
Qualifying activities include employment, job training, workforce development programs, half-time or greater educational enrollment, community service, and combinations of these. The total must reach 80 hours in a calendar month.
Can I lose Medicaid if I forget to claim my caregiver exemption?
Yes. If your state does not automatically identify your exempt status and you do not report your caregiver status, you could be treated as subject to the work requirement. If you then do not meet the 80-hour threshold, you could lose coverage. Responding to state outreach and reporting your status at renewal are the most important steps you can take.
Are non-expansion states affected by these work requirements?
No. The new work requirements apply specifically to the Medicaid expansion population, which exists only in states that expanded Medicaid under the ACA. The 10 states that have not expanded Medicaid are not required to implement these particular rules.
