Do the New Medicaid Work Requirements Affect My Medicare?

The new Medicaid work requirement has been in the news since a federal judge ruled on it at the end of July. If you're enrolled in Medicare, it doesn't apply to you.

The headlines don't lead with that. Most of the coverage has been about Medicaid without ever saying where Medicare stands.

I'm a licensed insurance agent in Rogersville, TN, serving Hawkins County and the surrounding area, and I'd rather you have the plain version than spend a week worrying about a rule that isn't yours.

01What did the judge actually decide?

On July 29, 2026, a federal judge turned down a request from 25 states and Washington, D.C. to pause parts of the new Medicaid work requirement while their lawsuit moves forward.

That's all he decided. He didn't rule that the policy is legal, and he didn't end the case. He denied it without prejudice, so those states can ask again.

The requirement stays on schedule for now. CMS issued the rule June 1, 2026, and states have to have it running by January 1, 2027. The court plans to rule on the heart of the case before then, so this isn't finished.

Tennessee is not one of the states that sued.

02Why does being on Medicare take you out of the rule?

According to the CMS fact sheet, the rule applies to non-pregnant adults ages 19 to 64 who are "not entitled to or enrolled in Medicare" and who are covered through the Medicaid adult group or certain waiver programs.

Medicare enrollment is written into the rule itself as the thing that takes you out of it.

So if you're 65 or older, you're past the age band. If you're under 65 and on Medicare through disability, you're excluded by name. Either way, it isn't yours to carry.

That holds even if you have both Medicare and TennCare. CMS has told states to find those people and exempt them automatically, using records the state already keeps. No paperwork from you.

If you're coming up on 65 and haven't enrolled yet, that's a different question with its own deadlines. I've written up what happens if you're still working at 65.

Not sure how this applies to your own situation? I'll walk through it with you. No cost for the help, and no obligation to enroll.

Logan Cope · Licensed Insurance Agent

Request a call

03Does this affect Extra Help or the Medicare Savings Programs?

No. Those are the two programs that help people with limited income pay their Medicare costs, and the work requirement doesn't reach either one.

Extra Help is a Medicare program, handled through Social Security. The Medicare Savings Programs run through the state, but they aren't the Medicaid adult group this rule targets. And anyone on either one is already on Medicare, which is the exclusion.

If you've never checked whether you qualify, it's worth a look. MACPAC, the federal commission that advises Congress on Medicaid, reports that many people who are eligible never enroll. Asking costs you nothing.

04Who in Tennessee does this actually affect?

Tennessee never expanded Medicaid, so most of what's been written about this rule is describing other states, not Hawkins County, TN.

We're not entirely outside it, though. According to the Georgetown University Center for Children and Families, Tennessee has to apply the requirement to one group covered under its TennCare III waiver: parents and caretaker relatives with income above the state's regular limit and up to the federal poverty line.

Even inside that group, most people won't have to do anything. The rule exempts caretaker relatives raising a child 13 or younger, anyone caring for a disabled family member, people who are medically frail, and anyone already working the hours or on SNAP. Georgetown also notes CMS may drop these small waiver groups entirely.

If you're under 65 and on TennCare and you're unsure where you land, TennCare can tell you at 1-855-259-0701. That's their question to answer, not mine.

05What to do next

1. If you're on Medicare, there's nothing to do. This isn't your rule.
2. If a letter about work requirements shows up and you're on Medicare, don't throw it away. Call the number printed on it and tell them you're enrolled in Medicare.
3. If someone in your household is under 65 and on TennCare, have them check with TennCare directly before January.
4. Don't give your Medicare number to anyone who calls you about this. Any rule change in the news gives a scammer a reason to dial.