Updated on August 14, 2025.
There are some changes to Medicaid that you should know about. These changes affect you in a few ways. Most importantly, you will need to do some things every month to keep your health benefits.
What are these changes? And what do you need to do? Here are some answers to these questions.
Why are there changes to Medicaid?
A new law was passed by Congress. It is called the 2025 Budget Reconciliation Act. It is also known as the One Big Beautiful Bill Act. This law makes changes to Medicaid. But there is time to prepare.
The new rules do not start right away. They begin on January 1, 2027. But states may be allowed to delay making these changes. This could happen if they need more time to get ready. Call your state's Medicaid office. They will have the newest information.
What are the changes?
There are some changes to Medicaid that affect you. You may have to do some things differently, such as:
- Submit required forms and documents more often
- Pay more for certain services
- Receive services in a different clinic
Here is why you may need to do these things.
There are new work requirements. Under the new law, many people on Medicaid will need to prove that they do one of the following:
- Work at least 80 hours each month
- Volunteer (do community service) for at least 80 hours each month
- Do a work program for at least 80 hours each month
- Go to school or take educational classes for at least 80 hours each month
- Work, go to school, and/or volunteer for a combined total of 80 hours each month
You do this by completing a form online. You also need to provide documents like a tax form, timesheet, or school form.
To submit these forms online you need to have internet access. You will also need a phone, tablet, or a computer.
You must meet the new work requirements if:
- You are between 19 and 64 years old.
- You are healthy enough to work (you do not have a disease or disability that prevents you from working).
There are some people who are exempt. This means they do not need to meet the monthly work requirements. Are you exempt?
You do not need to meet the Medicaid work requirement if:
- You have a child who is 13 or younger
- You have a child who is disabled
- You are a caregiver for a family member who is disabled
- You have a disease or disability to prevents you from working, volunteering, or going to school
- You are younger than 19
- You are older than 64
If you are exempt, you still need to show proof. You do this by completing a form online. You must also submit documents like a medical form, a birth certificate, or other records.
It is important that you remember to do this. You may lose your health benefits if you do not fill out this form every month or as required by your state.
There are new eligibility requirements: To receive Medicaid you must meet certain requirements, such as:
- Having a certain income
- Having children
- Being pregnant
- Being older than 65
- Having a disability
Some states expanded their Medicaid programs to include more people. These are called expansion programs. The new law changes how often these people need to prove they are eligible. Before they only had to do this one per year. Now they will have to do it every six months.
You may need to pay more for some services. Medicaid used to help pay for medical bills from three months before you applied. (This is called retroactive coverage.) The new law changes this. Now it will only help pay for bills from one to two months before you apply.
People who became eligible for Medicaid under expansion programs may also need to pay more for some services. But no single visit will cost more than $35.
You may need to find a new provider. If you receive care at Planned Parenthood you may need to find another option. Many people use Planned Parenthood clinics for routine care like cancer screenings and birth control. It is not clear if services at these clinics will still be covered. Your provider can help you know where to go. It is important to continue receiving these services.
What can you do to prepare for these changes?
Make sure you give Medicaid the right information for you. This includes your:
- Address
- Phone number
- Email address
- Any other information they can use to reach you and to identify you
Check your messages. Be sure to respond to any requests for information.
Find out if you are exempt from any new work requirements. If you do not know, ask for help. Here are some people who could help:
- Your healthcare provider (HCP)
- A social worker or Medicaid navigator (someone who helps people understand their health benefits)
- Your state’s Medicaid office
- Community health organizations near you
Prepare documents ahead of time. If you must meet a work requirement, keep track of your hours. This means you should track the dates and times you work, volunteer, or go to school. You should also gather the documents you need. If you are exempt, you still need to gather documents to prove it.
If you are working, some documents you may need include:
- Timesheets
- Pay stubs
- Tax forms
If you are exempt, you may need different documents such as:
- A medical report from your healthcare provider that proves you, your child, or your family member has a disease or disability
- Birth certificates or other proof that you have a child who is age 13 or younger
Do not wait until the deadline to apply. Apply for Medicaid early. This can help avoid losing your coverage for any length of time.
Ask your healthcare provider (HCP) if they are “in-network” for Medicaid. This means their services will be covered by Medicaid.
