Do you work with Medicaid clients?

Over 80% of Medicaid clients don’t know they’ll need to report work, education or volunteer hours starting in 2027 to maintain coverage, according to a survey from the Health Management Academy.

The new requirements

The enactment of the 2025 federal budget reconciliation bill, popularly known as the One Big Beautiful Bill, introduced new Medicaid work requirements.

Beginning January 1, 2027, these requirements will apply to 44 states, most that expanded their Medicaid coverage under the Affordable Care Act, plus  partial-expansion states Georgia and Wisconsin.  The new requirements mandate that able-bodied adult Medicaid enrollees document 80 hours of work, school, or volunteer community service each month to retain coverage.

Medicaid policies will vary by state.  But only 7 states will not be required to implement these work requirements: Florida, Texas, Wyoming, Kansas, Mississippi, South Carolina, and Alabama.

Many clients are still in the dark

The potential consequences of a lack of awareness or inability to comply with these new rules are alarming, as they could lead to care denials and cause thousands to lose their health insurance.

According to the survey, a staggering 55% of Medicaid clients are completely unaware of the new work requirements, while 27% have only heard vague mentions of these changes, but don’t know any specifics.

There are exceptions for certain groups, such as individuals under 19 or over 64, those enrolled in Medicare, pregnant or postpartum individuals, caregivers of children 13 or younger (or disabled dependents), and individuals who are medically frail, disabled, or in substance use disorder treatment. But millions of working individuals still face the risk of losing coverage due to complex bureaucratic hurdles and the daunting task of paperwork required to prove eligibility. An analysis by the Urban Institute and the Robert Wood Johnson Foundation projects that 3 million to 7 million people could lose coverage due to these requirements.

Impact of the new requirements

• Some clients may struggle to meet the 80 hours per month requirement due to caregiving responsibilities or personal health challenges.
• States may not have the administrative structures in place by January to efficiently check for compliance.
• The Bill requires Medicaid eligibility verification every 6 months, so clients must repeatedly go through this extra layer of bureaucracy.
• 37% of survey respondents said if they lost coverage they would wait until health concerns became urgent and go to the emergency room (ER). 28% said they would use the ER for routine care. Yet due to 2026 healthcare subsidy cuts, ERs are already reporting increased usage, and an increase in patients not paying for care.
• 41% of survey respondents reported they would ration their existing medication if they lost coverage.

The takeaway

Let’s help our clients retain their coverage. Talk to your Medicaid clients (or clients with family members using Medicaid) to ensure they know about the new requirements.

For more information, click here, and read KFFs Medicaid Implementation Tracker here.