Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Virginia

Medicaid work requirements in Virginia: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Virginia expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 588,844 of them (11.2% of an expansion pool of 629,482) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 198,960 people in Virginia lose coverage by 2034: 181,294 of them still eligible but lost to paperwork and reporting failures, and 17,665 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Virginia scores 63 of 100 on this model's ex parte capability index, a mid band; its eligibility system is VaCMS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureVirginia
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)629,482
Adults subject, strict definition588,844
Adults subject, permissive definition577,067
Share of expansion pool subject11.2%
Projected coverage loss by 2034198,960
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)63 (mid)

Who is subject in Virginia

Of the 588,843 subject adults, 39% already work 80 or more hours a month and 53% are not working. 38% have a child under 14 at home. Among those not working, 50% report a disability and 16% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2414%
Age 25-3422%
Age 35-4422%
Age 45-5418%
Age 55-6424%
Not working53%
1 to 19 hours a month1%
20 to 79 hours a month6%
80 or more hours a month (meets the bar)39%
Not working: Disabled50%
Not working: Caregiver16%
Not working: Postpartum0%
Not working: Student4%
Not working: Other29%

Why eligible people lose coverage

Of the 198,960 projected to lose coverage in Virginia, 181,294 meet the requirement or qualify for an exemption but fail to document it. 95,514 of those are working people who cannot prove their hours through data the state can see, and 85,781 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work28,274
Self-employed (other)19,989
Multiple part-time jobs (aggregation failure)18,997
Full-time students not auto-verified8,108
Volunteering / job training6,515
Cash-paid construction & trades5,033
Seasonal: agriculture, hospitality, food service4,814
Gig / courier (DoorDash, Uber, Lyft, Instacart)3,783
Medically frail without auto-match34,449
Caregivers of a disabled adult25,348
Parent caregivers of children ≤13 without auto-match7,543
American Indian / Alaska Native (tribal exemption)6,332
Kinship caregivers (non-parent) of children ≤134,401
SUD treatment not flagged in claims data4,189
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)1,824
Recent incarceration (data-match gap)1,325
Pregnancy / postpartum data lag370

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (61% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Virginia's composite score is 63 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite63
Observed ex parte61
Core capability60
Data sources72
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four198,27133.7%
Working ≥ qualifying hours / income104,02517.7%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1395,15116.2%
Medically frail84,52514.3%
Parent caregiver of child ≤1339,8426.8%
Full-time student22,0053.7%
Working ≥ qualifying hours / income + Full-time student17,5663.0%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13 + Full-time student6,8751.2%

Counties in Virginia

Subject adults concentrate: Fairfax County (77,678), Prince William County (31,389), and Virginia Beach city (28,325) account for 23% of the state's subject population.

All 133 counties in Virginia with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Fairfax County77,67811.1%26,2466.0%699,882
Prince William County31,38910.5%10,6066.0%298,284
Virginia Beach city28,32510.2%9,5708.0%279,145
Loudoun County26,85910.1%9,0754.0%265,686
Chesterfield County25,42511.4%8,5917.0%222,534
Henrico County21,78210.8%7,3608.0%201,614
Chesapeake city15,85710.4%5,3588.0%151,903
Richmond city13,9359.1%4,70919.0%152,850
Arlington County13,6918.4%4,6267.0%163,835
Norfolk city13,5208.9%4,56817.0%151,436
Newport News city11,25110.0%3,80115.0%112,447
Stafford County10,27510.3%3,4725.0%99,856
Spotsylvania County10,05711.6%3,3987.0%86,884
Montgomery County9,88915.3%3,34125.0%64,842
Hampton city8,64510.4%2,92113.0%83,000
Albemarle County8,58313.0%2,9007.0%65,870
Hanover County8,39212.8%2,8355.0%65,477
Alexandria city7,9587.4%2,6899.0%107,360
Frederick County6,75512.4%2,2827.0%54,672
Roanoke County6,75412.2%2,2827.0%55,428
Rockingham County6,52913.5%2,2069.0%48,272
Lynchburg city6,48213.2%2,19018.0%49,078
Bedford County6,37214.0%2,1539.0%45,527
Suffolk city6,27410.6%2,1209.0%59,326
James City County6,23414.7%2,1067.0%42,424
Roanoke city6,20310.8%2,09619.0%57,678
Augusta County5,90413.1%1,9958.0%45,210
Portsmouth city5,5609.5%1,87817.0%58,745
Fauquier County5,45412.5%1,8436.0%43,480
York County4,75511.6%1,6075.0%41,142
Franklin County4,48114.6%1,51413.0%30,760
Pittsylvania County4,47413.2%1,51216.0%33,927
Harrisonburg city4,43613.1%1,49927.0%33,763
Washington County4,16313.6%1,40712.0%30,522
Campbell County3,92112.2%1,32510.0%32,214
Henry County3,64313.3%1,23116.0%27,346
Charlottesville city3,61811.7%1,22324.0%30,948
Culpeper County3,57011.6%1,2067.0%30,884
Shenandoah County3,32013.4%1,12213.0%24,836
Louisa County3,00612.9%1,01611.0%23,296
Warren County2,96611.9%1,00212.0%25,006
Tazewell County2,92313.4%98818.0%21,874
Isle of Wight County2,91612.6%98510.0%23,069
Gloucester County2,86512.4%9687.0%23,038
Danville city2,81912.1%95225.0%23,268
Orange County2,73012.6%92213.0%21,613
Accomack County2,65815.2%89816.0%17,538
Manassas city2,6139.9%8835.0%26,329
Botetourt County2,56813.5%8687.0%19,066
Prince George County2,5149.1%8498.0%27,546
Halifax County2,44613.7%82615.0%17,850
Pulaski County2,42912.3%82113.0%19,726
Wise County2,41511.4%81620.0%21,223
Mecklenburg County2,33814.2%79019.0%16,420
Amherst County2,29012.8%77411.0%17,859
Powhatan County2,26611.8%7665.0%19,239
Carroll County2,23813.8%75615.0%16,178
Prince Edward County2,17115.8%73318.0%13,774
Smyth County2,10812.6%71219.0%16,710
Goochland County2,10113.8%7104.0%15,210
Fredericksburg city2,04511.0%69118.0%18,646
King George County2,01812.0%6827.0%16,774
Dinwiddie County2,01312.0%68011.0%16,814
Wythe County2,00012.3%67617.0%16,194
Petersburg city1,98210.1%67022.0%19,630
Caroline County1,94610.1%65712.0%19,194
Fluvanna County1,94611.9%6576.0%16,288
Salem city1,92112.7%64910.0%15,082
Russell County1,89513.1%64019.0%14,476
Winchester city1,88011.5%63517.0%16,350
New Kent County1,87812.2%6344.0%15,368
Rockbridge County1,83515.0%6209.0%12,252
Page County1,81113.4%61210.0%13,536
Williamsburg city1,72317.7%58214.0%9,718
Fairfax city1,68311.2%56910.0%15,012
Scott County1,57613.1%53217.0%12,032
Radford city1,57013.5%53034.0%11,623
Lee County1,56512.4%52926.0%12,646
Staunton city1,53810.2%52011.0%15,033
Greene County1,45312.2%49111.0%11,927
Hopewell city1,43210.6%48421.0%13,503
Waynesboro city1,42110.5%48016.0%13,510
Westmoreland County1,37413.3%46416.0%10,321
Patrick County1,34314.3%45411.0%9,412
Buchanan County1,31111.5%44325.0%11,358
King William County1,29111.7%4368.0%11,056
Giles County1,25513.2%42410.0%9,548
Nelson County1,25316.3%42413.0%7,699
Floyd County1,22614.0%4149.0%8,732
Colonial Heights city1,21811.8%41210.0%10,340
Bristol city1,21613.1%41117.0%9,312
Appomattox County1,21113.0%40914.0%9,292
Southampton County1,17711.2%3988.0%10,492
Alleghany County1,17014.5%39514.0%8,080
Lexington city1,15923.6%39217.0%4,906
Northumberland County1,13919.8%38515.0%5,755
Grayson County1,12312.9%38019.0%8,724
Brunswick County1,10011.3%37217.0%9,754
Clarke County1,08312.6%3665.0%8,576
Madison County1,06213.6%3598.0%7,790
Buckingham County1,03410.1%35014.0%10,214
Amelia County1,02913.4%34811.0%7,664
Manassas Park city1,0289.3%3475.0%11,050
Falls Church city1,01911.7%3442.0%8,676
Dickenson County98612.9%33322.0%7,643
Nottoway County96710.3%32719.0%9,394
Northampton County94615.2%32017.0%6,226
Lancaster County91218.5%30814.0%4,927
Middlesex County90216.9%30510.0%5,353
Poquoson city89312.6%3024.0%7,090
Martinsville city86311.5%29225.0%7,497
Lunenburg County83012.3%28013.0%6,746
Charlotte County82813.3%28020.0%6,240
Cumberland County77914.2%2638.0%5,484
Essex County74812.5%25317.0%5,978
Mathews County70516.0%2387.0%4,404
Greensville County6969.2%23513.0%7,534
Sussex County6739.7%22713.0%6,926
Rappahannock County62515.5%2118.0%4,034
Charles City County54514.2%18412.0%3,830
Franklin city54212.3%18319.0%4,423
Surry County53214.4%18013.0%3,693
Richmond County5299.6%1798.0%5,528
Buena Vista city52614.4%17822.0%3,642
King and Queen County44211.4%14920.0%3,896
Bland County42211.3%14311.0%3,748
Craig County39314.2%13311.0%2,764
Galax city39210.9%13322.0%3,595
Covington city35311.3%11917.0%3,126
Emporia city34511.7%11717.0%2,942
Norton city27413.8%9329.0%1,992
Bath County27012.0%9124.0%2,250
Highland County18315.7%6210.0%1,164

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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