Medicaid: Federal Work Requirement Exemptions
Do I qualify for an exemption?
If you are enrolled in BadgerCare Plus and are between 19 and 64 years old, not pregnant, not disabled, and don’t have dependent children under 19 living with you, you may need to meet the federal work requirement. However, there are many other reasons (called exemptions) why you may not need to meet it. Some exemptions are for medical reasons, and others are for things like being a Tribal member or getting other kinds of public benefits. Learn more about exemptions and how to get one.
Types of exemptions
Medical exemptions
Some exemptions are for medical reasons. You can get a medical exemption if you have any of these:
- Drug or alcohol disorder that makes it hard to work 80 hours in a month.
- Mental health disorder that makes it hard to work 80 hours in a month.
- Physical, intellectual, or developmental disability that makes it hard to do daily activities and affects your ability to work.
- Serious or complex medical condition that makes it hard to work 80 hours in a month.
You may also get a medical exemption for a qualifying short-term medical hardship situation.
Other exemptions
You may also be exempt if you are:
- A member of an American Indian tribe or an Alaska Native, or the child or grandchild of a Tribal member. See our fact sheet Federal Medicaid Work Requirement: Information for Tribal Members, P-03809C.
- A caregiver of a dependent child under age 14 or someone with a disability. See our fact sheet Federal Medicaid Work Requirement: Information for Caregivers, P-03809F.
- Someone who is pregnant or was pregnant in the last 12 months.
- A veteran with a total (100%) disability rating.
- Participating in a qualifying drug addiction or alcoholic treatment and rehabilitation program.
- In prison or jail, or were in prison or jail in the past four months.
- Complying with Wisconsin Works (W-2) work requirements.
- Enrolled in FoodShare and not exempt from FoodShare work requirements.
- Under age 19 in the month you applied for benefits.
- Entitled to or enrolled in benefits under Medicaid Part A or Part B.
- A former foster care youth.
- Enrolled in or were recently enrolled in another full-benefit Medicaid eligibility group.
- Experiencing a short-term hardship situation.
Medical exemptions—more information
Automatically applied medical exemptions
We can often give you an exemption based on information we already have on file or from other data sources. For example, we’ll use the medical bills your health care provider sends to us to see if we can give you a medical exemption automatically. This is an automated process in our system, and your medical information will not be shared with your local agency.
Self-reported medical exemptions
If we can’t give you a medical exemption based on information we already have on file, you can get an exemption by telling us you have a medical reason for not meeting the work requirement. To do this:
- You do not need a diagnosis.
- You do not need to tell us what the condition is.
- The specific condition will not be recorded in our eligibility system.
- You do not need to provide verification.
- Your provider will not be asked to report on your condition.
Short-term medical hardship
You can get a short-term hardship exemption if you:
- Had inpatient care at a hospital, nursing facility, psychiatric hospital, or intermediate care facility for individuals with intellectual disabilities, or other similar inpatient services.
- Needed to travel at least 45 minutes from your home to receive medical services necessary to treat a serious or complex medical condition, requiring multiple appointments or an overnight stay, for yourself or your dependent.
To get a short-term medical hardship exemption, you must complete and submit an individual declaration form.
Medical exemption FAQs
For new applicants, you’ll see five optional questions when you first apply for benefits. For existing members, we’ll ask them when you renew your health care coverage. You’ll get a medical exemption if you answer “yes” to one or more of these questions:
- Are you living with a drug or alcohol disorder that makes it hard for you to work 80 hours in a month?
- Are you in a treatment program for a drug or alcohol disorder?
- Are you living with a physical, intellectual, or developmental disability that makes it hard to do daily activities and affects your ability to work?
- Are you living with a serious or complex medical condition that makes it hard for you to work 80 hours in a month?
- Are you living with a mental health disorder that makes it hard for you to work 80 hours in a month?
No. If you have a disability determination from the Social Security Administration (SSA), that is an exemption from the work requirement. This exemption will be applied automatically, because we will already have that information on file. You do not have to get another disability determination.
No. Someone who has a serious or complex medical condition does not need a disability determination to qualify for an exemption. See our fact sheet Federal Medicaid Work Requirement: Information for People with Disabilities, P-03809E.
Maybe. There are a few different ways in which someone who is waiting on a disability determination still might be able to get an exemption. If you are already enrolled in a Wisconsin Medicaid long-term care program like Family Care or IRIS, you will get an exemption automatically. If you aren’t enrolled in a Medicaid long-term care program, then another possibility would be to get an exemption based on having a serious or complex medical condition.
No. If someone is getting Supplemental Security Income (SSI), it means they are not subject to the work requirement.
No. Members enrolled in a Medicaid long-term care program (IRIS, Family Care, Family Care Partnership, PACE) do not have to meet the work requirement. They will automatically be exempt based on their enrollment in a long-term care program. They do not need to have a disability determination from the Social Security Administration.
Other exemptions—more information
Automatically applied
As with medical exemptions, we will use information on file or from other data sources to give you an exemption. For example, we can give you an exemption automatically if it is based on getting other state programs, like FoodShare or Wisconsin Works (W-2).
Self-reported exemptions
In many cases, you can tell us if you have an exemption and you don’t need to provide other verification. For example, you can get an exemption by reporting your:
- Current or recent pregnancy
- Tribal status
- Current or recent incarceration
For other exemptions, we may ask you to complete a form or provide additional verification. For example:
- A veteran with a total disability rating needs to provide documentation from the U.S. Department of Veterans Affairs.
- A caregiver of a dependent child under age 14 or of someone with a disability must complete and submit an individual declaration form.
Short-term hardship
You will get an exemption automatically if you are:
- Living in a county that was affected by an emergency or disaster declared by the President.
- Living in an area where the unemployment rate is at or above 8% or 1.5 times the national unemployment rate, whichever is lower.
Other exemptions FAQs
This is tricky, but the caregiver exemption is different. It applies only to people who are subject to the work requirement. If you are a parent with a dependent child under 19 lives who with you at least 40% of the time, you are not subject to the work requirement. See our fact sheet Federal Medicaid Work Requirement: Information for Parents. P-03809D.
There are four types of people who could meet this exemption.
- Parent: An individual with the legal status of a mother or father who provides some level of care to a dependent child under age 14 or to a person of any age with a disability.
- Guardian: An adult appointed by a court to care for and make personal decisions for a dependent child under age 14 or person with a disability who cannot care for themselves.
- Caretaker relative: Someone with a qualifying relationship who provides some level of care to a dependent child under age 14 or person of any age with a disability.
- Caregiver: Someone who provides paid or unpaid caregiving to a dependent child under age 14 or a person with a disability and meets one of these criteria:
- They primarily live with the person they are caring for and provide assistance on a regular basis.
- They are a relative of, but do not live with, the person they are caring for and provide assistance on a regular basis.
- They do not live with and are not a relative of the person they are caring for and provide at least 80 hours of assistance per month. If they provide less than 80 hours of assistance per month, their caregiving hours may be combined with other work requirement activities.
Homelessness was not included in the One Big Beautiful Bill Act (OBBBA) as a reason that someone can be exempt from the work requirement. States are not allowed to add exemptions beyond what is established in federal law. If you are homeless you will still need to meet the work requirement unless you have an exemption.