Medicaid hours log
Print a one-page log and write your hours by hand, or track them online in log80. Both are free. You can keep the sheet for yourself and send what your state asks for.
Medicaid hours log
Write each work, school, job training, community service or volunteer session. Add up the hours at the bottom.
Name:
Month and year:
| Date | Activity | Place | Start | Stop | Hours |
|---|---|---|---|---|---|
Month total (hours):
Signature:
Date:
Log it online instead
In log80 you tap Start when you begin and Stop when you finish. Your date, activity and time are saved, and your monthly report adds up the hours next to 80. Use it in your browser, or get the Android app on Google Play. iPhone is coming soon.
iPhone coming soonDoes your state have its own form?
Some states publish their own forms and portals. Each state page on log80 lists the official links. Find your state. To learn what proof people keep, see how to show your Medicaid hours.
Questions
- Is the printable log free?
- Yes. You can print this page or download the PDF at no cost. You do not need an account.
- What goes on the log?
- Write the date, the activity (work, school, job training, community service or volunteering), the place, the start and stop times, and the hours. At the bottom, add up the month.
- Does my state have its own form?
- Some states do. Check your state page for its official links. This log is a simple record you can keep for yourself.
- Can I track online instead?
- Yes. log80 is free in your browser and on Android. Tap Start and Stop, and your monthly report adds up the hours next to 80.
More from log80
Log80 keeps your proof in one place.
Track your hours and make a monthly report to share with your state Medicaid office. It's free, in your browser or on Android.
Log80 is not a government service and is not Medicaid. This page is not legal advice. Your state Medicaid office decides who needs to meet the rule and what proof it takes.