Under H.R. 1, also known as the "Great and Beautiful Act," signed into law last year, low-income Americans aged 19 to 64 must meet mandatory federal work requirements to obtain and retain Medicaid coverage through the Affordable Care Act's expansion. This means these adults must work or participate in community service for at least 80 hours per month, or be enrolled in educational programs for at least half of the time. Parents raising young children, caregivers, or those who are physically frail are exempt. The new rules will place an additional burden on retirees, residents of rural areas, and individuals whose work hours are insufficient to meet the requirements.