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flag Most low-income adults must work, volunteer, or study 80 hours monthly to keep Medicaid under new federal rules aimed at saving $388 billion.

flag Starting January 1, 2026, millions of lower-income adults in most U.S. states must work, volunteer, or study at least 80 hours monthly to maintain Medicaid coverage, under new federal rules tied to a tax-cut law. flag The changes, aimed at saving $388 billion over ten years by reducing enrollment by 6 million, require biannual eligibility reviews. flag States face over $1 billion in costs to modernize outdated computer systems, improve online portals, and verify participation, despite a $200 million federal aid allocation. flag Many states rely on private contractors and existing contracts to meet deadlines, while grappling with challenges like verifying volunteer hours and defining exceptions. flag Federal penalties for payment errors begin in October 2029.

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