The new federal rules require many beneficiaries to document qualifying work or other approved activities to maintain coverage. According to KFF Health News, state Medicaid agencies are now preparing new administrative systems while encouraging enrollees to update their contact information before the changes take effect.
New Eligibility Rules Will Apply Only to Medicaid Expansion Enrollees
The new requirements stem from federal rules released by the Centers for Medicare & Medicaid Services (CMS) in June, following the One Big Beautiful Bill Act. According to KFF Health News, adults covered through Medicaid expansion will generally need to demonstrate that they work, volunteer, participate in job training, or attend school for at least 80 hours each month in order to remain eligible for coverage. States will also require these beneficiaries to renew their eligibility every six months rather than once a year.
Not every Medicaid recipient will be affected. Children, pregnant people, and individuals receiving Social Security disability benefits are exempt from the work requirements. Other groups, including disabled veterans, former foster youth, people caring for a child younger than 14, and individuals considered medically frail, may also qualify for exemptions under specific conditions.
The impact will be significant in the District of Columbia. According to WAMU, approximately 119,000 Medicaid recipients in the District (about half of all enrollees and nearly one in five residents) will be subject to the new rules. Maryland and Virginia also expanded Medicaid, meaning many expansion beneficiaries in those states will be affected as well.
CMS Administrator Dr. Mehmet Oz said during a June press briefing that the agency expects the work requirements to redirect Medicaid resources toward people “truly in need.” At the same time, state agencies are working to adapt their information technology systems and staffing to administer the new eligibility process.
Documentation Requirements and Exemptions May Create New Administrative Challenges
The federal rules include temporary measures intended to ease the transition during the first year. According to KFF Health News, beneficiaries will be allowed to self-attest in 2027 if they are medically frail or if states cannot automatically verify that they completed the required 80 hours of qualifying activities through existing employment or education records.
Beginning later in the implementation period, states may require additional documentation if automated verification is unavailable. Medical professionals may need to provide statements explaining why an individual’s health condition prevents employment, while beneficiaries engaged in volunteer work or unpaid internships may need documentation confirming their participation.
Andrew Patterson, senior counsel at Legal Aid D.C., told KFF Health News that the additional reporting requirements could increase administrative burdens for both agencies and beneficiaries, creating more opportunities for eligible people to lose coverage because of procedural issues rather than changes in eligibility.
Health policy experts interviewed by KFF Health News also encourage Medicaid recipients to prepare before the rules take effect. Beneficiaries are advised to confirm that their mailing address, phone number, and other contact information are current with their state Medicaid agency and to pay close attention to official notices sent by mail, email, text message, or phone. Maryland and Virginia have already posted information about the upcoming changes on their Medicaid websites, while local benefits offices remain available to answer questions from enrollees before implementation begins in January 2027.
