Changes to Medicaid eligibility begin on Jan. 1, 2027, or earlier in some states. To qualify for Medicaid, some people must meet new federal work requirements and verify eligibility every six months instead of annually.
These changes apply only to adults 19 to 64 who aren’t considered disabled by the government, aren’t pregnant or post-partum and aren’t enrolled in or eligible for Medicare coverage.
Most people with pulmonary hypertension or caregivers for people with PH are likely to be exempt. However, anyone with Medicaid insurance should still follow all steps below to avoid losing coverage due to administrative errors.
How to avoid losing Medicaid coverage
- Keep your mailing address, phone number and email up to date with your state’s Medicaid agency.
- Check your mail regularly and respond immediately to any mail from Medicaid.
- Send documentation when asked. Contact your state’s Medicaid agency as soon as possible if you are struggling to find or submit requested documents.
- Update Medicaid about life changes, such as income, pregnancy, ability to work or if someone moves into or out of your home.
- Use our dropdown menu on this page to find your state’s Medicaid work requirement updates.
Three states have chosen to begin these changes in 2026: Nebraska on May 1; Montana on July 1; Iowa on Dec. 1. Arkansas soft-launched changes on July 1, but won’t disenroll people until Jan. 1, 2027.
Medicaid eligibility changes
To qualify for Medicaid, certain adults must meet the work requirement by either earning a monthly income of $580 or showing they spend 80 hours per month doing some combination of:
- Paid work or self-employment
- Job training from a federal- or state-recognized program
- Education
- Volunteering activities, e.g. with a nonprofit, school or other organization
- Unpaid caregiving for a dependent child or person with disability
These same adults will also now have their Medicaid eligibility reviewed every 6 months instead of every 12 months.
Who’s affected
These changes apply only to people enrolled in their state’s Medicaid Expansion program. People within this group are exempt from Medicaid work requirements if they are:
- Considered medically frail (e.g., have a serious or complex medical condition)
- Caretakers of a child 13 years or younger, or a person of any age with a disability
- Adults under age 26 who aged out of the foster care system at 18
- Veterans with a total disability rating
- Members of federally recognized tribes
- Enrolled in an addiction treatment program
- Already meeting work requirements for SNAP or TANF
Find your state’s Medicaid website
Select your state in the dropdown menu to quickly find your state’s Medicaid webpage with work requirement updates. From there, you can update your contact information and learn more about your state’s specific plan for implementing these changes.
Frequently asked questions from the PH community
Maybe. States will receive less federal funding for Medicaid. Each state will determine how to cover the cost of these changes and make up the difference from this funding loss. Some states may choose to shrink formulary lists or take other cost-saving measures.
No. Copay assistance is typically provided by non-profit foundations. Programs already offering assistance to people with Medicaid shouldn’t be affected.
The work requirements can be met by earning a monthly income of $580 (equal to 80 hours per month at federal minimum wage, $7.25). Seasonal workers can meet the work requirements if they earn an average income of $580 per month over 6 months.
Where to learn more
Call PHA’s Treatment Access Program at 240-485-0758 or email us with questions.
What You Should Know About Medicaid Changes
This PHA Live video recording explains how new work requirements will affect Medicaid eligibility and which groups are exempt.
Watch the video