States must implement Medicaid work requirements for expansion enrollees by year-end under the One Big Beautiful Bill Act

Expansion enrollees ages 19–64 must report 80+ hours/month of work or 'community engagement' or lose coverage. States may request a HHS-granted delay until December 31, 2028. Medicaid redeterminations become biannual — states must re-check eligibility every 6 months for expansion enrollees (previously annual).