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flag Starting Jan. 1, 2026, 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 major tax-cut law. flag The changes, which require biannual eligibility reviews, aim to save $388 billion over ten years by reducing enrollment by 6 million people. flag States face significant costs—projected to exceed $1 billion—to upgrade outdated computer systems, improve online portals, and verify participation, despite a $200 million federal aid allocation. flag Many states rely on private contractors and lack centralized databases for volunteer or employment data, complicating implementation. flag The federal government will cover up to 90% of system development costs but will penalize states with excessive payment errors starting October 2029.

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