Medicaid: New eligibility requirements coming in 2027

In 2025, H.R.1 introduced new Medicaid eligibility requirements for certain adults enrolled through the Medicaid expansion. Beginning no later than Jan. 1, 2027, adults ages 19–64 who don’t qualify for an exemption will be required to regularly demonstrate participation in work or other community engagement to maintain eligibility. Exemptions, exclusions and all required documentation and verification will be managed by state Medicaid and may vary by state. 

What may be required

To maintain Medicaid eligibility, members may be required to:

• Complete at least 80 hours per month of qualifying work, education, training or volunteer activities
• Renew Medicaid coverage every 6 months instead of annually
• Provide additional documentation related to eligibility and renewal requirements

Exemptions and exclusions

Certain members may qualify for exemption, including:

• Individuals under 19 or over 65
• Pregnant or postpartum individuals
• People who are eligible for Medicare
• Certain caregivers 
• Individuals meeting SNAP or TANF work requirements
• Individuals who meet applicable medical frailty or disability-related criteria 
• People participating in qualifying substance use disorder (SUD) treatment programs
• Former inmates of a public institution during the last 3 months
• Native Americans and certain other groups
• Other individuals identified through federal and state guidance

What you can do

State Medicaid agencies will provide guidance to members, but you play an important role in supporting them through changes.

• Encourage patients to keep contact information updated
• Remind patients to open and respond to all Medicaid notices
• Refer patients to Medicaid resources regarding work requirements and renewal changes
• Identify patients who may qualify for medical frailty or other exemptions and encourage them to respond promptly to state requests for information

Member resources

Direct members to their state Medicaid resources for the latest information.