Changes are coming to Medicaid programs across the country because of a federal law passed in 2025, commonly referred to as H.R. 1 or the “One Big Beautiful Bill.” Because these changes are complex, will take effect at different times in different states, and are still being finalized in some areas, there is already a lot of confusing and inaccurate information circulating.
If you receive Medicaid coverage, the most important thing you can do right now is stay informed. Keep your contact information up to date with your state Medicaid agency, and pay close attention to any letters, texts, emails, or portal notifications you receive. States may contact more people than will ultimately be affected by the changes, so receiving a notice does not necessarily mean you are losing coverage.
The goal of this article is to help separate facts from rumors, explain the changes in plain language, and help you understand what steps you may need to take to protect your Medicaid coverage.
What is Changing with Medicaid?
The changes will not affect every Medicaid member in the same way. Who is affected, when the changes begin, and what someone may need to do will depend on factors such as their state, eligibility category, and individual circumstances.
Three of the biggest changes involve community engagement requirements, more frequent eligibility renewals, and the way exemptions may be verified.
- Community engagement requirements: In states where these rules apply, certain adults may need to show that they are participating in qualifying activities for about 80 hours each month or meet an applicable income threshold. These activities are not limited to paid employment. Work, volunteering, job training, school, or a combination of qualifying activities may all count.
- More frequent Medicaid renewals: Some adults covered through Medicaid expansion may need to renew their eligibility every six months instead of once a year. This does not apply to everyone on Medicaid, and implementation timelines will vary by state.
- Verification of exemptions: Some individuals may qualify for exemptions from community engagement requirements, including people receiving substance use disorder treatment, people who meet medical frailty criteria, pregnant individuals, and certain caregivers. However, states are still determining how some exemptions will be documented and verified. Even if you believe you qualify for an exemption, it is important to respond to any Medicaid renewal or verification request you receive.
Because these changes are being implemented differently from state to state, it is important not to rely on assumptions or secondhand information. The sections below address some of the most common misconceptions and explain what Medicaid members should know.
Myth #1: Medicaid Work Requirements Mean You Need a Job
One of the biggest misconceptions about the upcoming Medicaid changes is that anyone affected by the new rules will need to have a full-time or part-time job to keep their coverage. That is not the case.
The federal government refers to these rules as community engagement requirements, and paid employment is only one way to meet them. In states where the requirements apply, certain adults may need to complete about 80 hours each month of qualifying activities or meet an applicable income threshold. Those activities may include:
- Paid work
- Volunteer service
- Job training
- School or education
- A combination of qualifying activities
Unpaid activities can count toward the requirement, which means someone may be able to meet the rules without having a traditional job. The important thing is to understand what your state considers a qualifying activity and whether the requirement applies to you. Because states are responsible for carrying out these changes, the exact process for reporting or verifying participation may vary.
Myth #2: Everyone on Medicaid Will Have to Renew Every Six Months
Another common concern is that every person enrolled in Medicaid will soon have to renew their coverage twice a year. The six-month renewal change is more limited than that.
According to the current federal requirements, more frequent renewals apply to a specific group of adults covered through Medicaid expansion under the Affordable Care Act, generally people between the ages of 19 and 64. The change does not broadly apply to every Medicaid member. Children, people who are pregnant, people enrolled based on a disability, and certain other groups are not included in this requirement.
Timing also differs by state. Some states will begin moving affected members to six-month renewal cycles in early 2027, while others will phase in the change later. If you receive Medicaid, the safest approach is to pay attention to your own renewal date and any communication from your state Medicaid agency rather than assuming that someone else’s renewal schedule applies to you.
Myth #3: If I Am in Treatment, Pregnant, or Have a Health Condition, I Am Automatically Exempt
There are exemptions from some of the new Medicaid requirements, but qualifying for an exemption may still involve additional steps.
Current federal guidance includes potential exemptions for people who meet certain criteria, including those receiving substance use disorder treatment, people who are medically frail, people who are pregnant, and some caregivers. However, states are still finalizing exactly how these exemptions will be documented and verified. That means you should not assume that Medicaid will automatically recognize an exemption without any action from you.
If you receive a renewal notice, verification request, or other communication from your state Medicaid agency, respond even if you believe you qualify for an exemption. You may be asked to provide information or documentation so the state can confirm your eligibility.
For people receiving treatment for substance use disorder, this is especially important. Receiving treatment may be relevant to an exemption, but the source document makes clear that states are still determining how those exemptions will be verified. Staying current with Medicaid notices and responding when requested can help prevent avoidable problems with your coverage.
Medicaid Changes Will Look Different from State to State
Although the Medicaid changes come from federal law, they will not take effect the same way or at the same time everywhere. Each state is responsible for implementing the requirements, which means start dates, renewal schedules, and who is affected can vary.
Here is what Medicaid members should know in the states where Community Medical Services provides care:
- Alaska: Community engagement requirements are currently scheduled to take effect January 1, 2027, for adults covered through Medicaid expansion. However, Alaska has requested additional implementation time from the federal government, so that date could change.
- Arizona: AHCCCS plans to begin community engagement requirements and six-month renewals for adults in the Medicaid expansion group on January 1, 2027. If your renewal begins processing in 2026, you will remain on a 12-month renewal cycle until your 2027 renewal.
- Colorado: Community engagement requirements and six-month renewals are scheduled to begin January 1, 2027, for adults in Colorado’s Medicaid expansion, or MAGI Adult, group. Current guidance indicates that the state will not receive a delay in implementation.
- Indiana: The Healthy Indiana Plan, or HIP, will begin enforcing community engagement requirements on January 1, 2027. New applicants beginning that month will need to show three consecutive months of compliance before applying, covering October through December 2026.
- Michigan: Community engagement requirements for the Healthy Michigan Plan will apply to new applications beginning January 1, 2027. Current members will begin being reviewed for the requirement when they renew on or after March 1, 2027.
- Minnesota: Medical Assistance work and community engagement requirements take effect January 1, 2027, for adults 21-64 without dependent children. The Minnesota Department of Human Services has an online tool to help people prepare ahead of their 2027 renewal.
- Montana: These changes are already in effect. Community engagement requirements and six-month Medicaid redeterminations began July 1, 2026, followed by a three-month education period that ended October 1, 2026. Medicaid members in Montana should pay particularly close attention to notices and requests from the state.
- North Dakota: Community engagement requirements are scheduled to begin January 1, 2027, for adults covered through Medicaid Expansion. Tribal members are excluded from both the community engagement requirement and the six-month renewal change.
- Ohio: Adults in Ohio’s Group VIII Medicaid expansion population will begin facing community engagement requirements and six-month renewals with the January 2027 renewal cycle. According to current guidance, the first potential coverage losses for people who do not meet the requirements would not occur until April 1, 2027.
- Oregon: Community engagement requirements are scheduled to begin January 1, 2027, for Oregon Health Plan adults ages 19–64. Six-month renewals will begin phasing in later in 2027. This represents a significant change in Oregon because many members currently renew only once every two years.
- Texas: The federal community engagement requirement does not apply to most Texas Medicaid recipients because Texas did not expand Medicaid under the Affordable Care Act. However, other changes are still coming, including a shorter retroactive coverage period and increased automated eligibility checks beginning January 1, 2027.
- Washington: Apple Health for Adults members will begin facing community engagement requirements and six-month renewals at their first renewal on or after January 1, 2027. Children, pregnancy coverage, and long-term care are not affected by these changes.
- Wisconsin: BadgerCare Plus community engagement requirements will apply to new applicants beginning January 1, 2027, while current members will begin being affected at renewals starting in March 2027. Under the current rules, members only need to demonstrate compliance for one month since their last renewal rather than for every month in between.
What Should You Do to Protect Your Medicaid Coverage?
With different requirements taking effect at different times, it can be difficult to know whether a Medicaid change applies to you. Fortunately, there are several steps you can take now to help avoid missing an important notice or deadline.
- Keep your contact information up to date. Make sure your state Medicaid agency has your current mailing address, phone number, and email address. If your information changes, update it as soon as possible so important notices will reach you.
- Read every Medicaid notice you receive. Pay attention to letters, texts, emails, and messages in your Medicaid portal, even if you do not think the new requirements apply to you. States may contact people who ultimately will not be affected, but you should still review every notice to determine whether you need to take action.
- Respond to renewal and verification requests. If your state asks you to renew your coverage or provide additional information, follow the instructions and deadlines included in the notice. Do not assume that an exemption or your current eligibility status means you can ignore a request.
- Use official state resources. Medicaid changes can be complicated, and information shared through social media, friends, or other unofficial sources may be incomplete or outdated. Use your state’s official Medicaid website or screening tools whenever possible to understand the requirements that apply to you.
- Ask questions if you are unsure. If you do not understand a notice or are unsure what you need to do, contact your state Medicaid agency, caseworker, or health plan. The Community Medical Services team can also help point you toward resources where you can find accurate information.
Frequently Asked Questions About Medicaid Changes
Will everyone on Medicaid have to renew every six months?
No. The six-month renewal requirement applies to certain adults covered through Medicaid expansion, generally ages 19–64. It does not broadly apply to every Medicaid member. Children, people who are pregnant, people enrolled based on a disability, and other groups may not be subject to the change.
When do the new Medicaid requirements begin?
There is no single implementation date for everyone. Requirements and renewal changes vary by state, with many changes scheduled to begin in 2027. In Montana, some changes are already in effect as of 2026. Check your state’s official Medicaid resources for the most current information about deadlines and requirements that may apply to you.
Does receiving a Medicaid notice mean I am going to lose my coverage?
Not necessarily. States are required to communicate with more people than may ultimately be affected by the changes. Receiving a letter, email, text, or portal notification does not by itself mean your coverage is ending. However, you should read every notice carefully and respond if action is required.
What should I do if I do not understand a Medicaid notice?
Do not ignore it. Contact your state Medicaid agency, caseworker, or health plan for clarification. You can also talk with the Community Medical Services team if you need help identifying the appropriate resource for more information.
Stay Informed About Your Medicaid Coverage
Changes to Medicaid can understandably create questions, especially when different rules and timelines are being discussed at the same time. What you hear about another person’s coverage or another state’s requirements may not apply to your situation.
The most important thing you can do is stay connected to your state Medicaid agency. Keep your contact information current, read every notice you receive, and respond when additional information or a renewal is requested. If you are unsure what a notice means, ask questions rather than assuming that you are exempt or that your coverage is ending.
Medicaid requirements and implementation timelines may continue to change as additional federal and state guidance becomes available. Community Medical Services will continue working to help patients access accurate information and understand where to turn when they have questions about their coverage.
If you receive Medicaid while receiving treatment at CMS and are unsure where to find more information, talk with your care team. We can help point you toward the appropriate state resources so you can better understand the next steps.
