WASHINGTON — State Medicaid agencies have begun notifying millions of beneficiaries about upcoming eligibility and reporting changes tied to new federal requirements, as states prepare to implement revised rules affecting certain adult enrollees beginning in 2027, according to federal and state officials.
The notices follow guidance issued on June 1 by the U.S. Centers for Medicare & Medicaid Services (CMS), which established a nationwide framework for implementing new community engagement, or work, requirements for certain Medicaid recipients. CMS said states generally must have the requirements in place by Jan. 1, 2027.
Under the rule, certain non-pregnant adults ages 19 to 64 enrolled through Medicaid expansion programs will be required to complete at least 80 hours per month of qualifying activities, including employment, education, job training, work programs or community service, unless they qualify for exemptions. Federal officials said exemptions include people who are pregnant, medically frail, disabled, receiving postpartum care, or already meeting certain federal assistance program requirements.
Several states have launched outreach campaigns advising beneficiaries to update contact information, monitor mail from Medicaid agencies and prepare for additional eligibility verification requirements. Montana, for example, has informed members that more frequent reviews, new reporting obligations and community engagement requirements are expected under forthcoming federal guidance.
CMS Administrator Dr. Mehmet Oz said in a June 1 statement that the rule is intended to implement changes enacted by federal law. “This rule helps Americans build skills and independence through work, education, job training, or community service,” Oz said.
Federal officials said states will be required to verify eligibility regularly, generally at least every six months, although states may conduct checks more frequently. CMS has also said states will receive federal funding to support implementation efforts.
The rollout has drawn criticism from some state leaders and congressional Democrats, who have raised concerns about administrative burdens and the possibility that eligible beneficiaries could lose coverage because of paperwork or reporting problems. Oregon Governor Tina Kotek, speaking on behalf of a coalition of Democratic governors seeking a slower implementation schedule, said states face significant operational challenges under the current timeline.
According to CMS, the new requirements will apply in states that expanded Medicaid eligibility under the Affordable Care Act and certain waiver programs. Federal guidance indicates states may begin implementation earlier but must generally comply by the start of 2027.
As of Thursday, state agencies continued distributing notices and updating beneficiaries through mailings, websites and enrollment materials. Details of implementation may continue to evolve as CMS accepts public comments on the interim rule through the summer, federal officials said.
