Big changes are coming to Medicaid, the program that provides free or low-cost healthcare coverage to nearly one in five Americans.

Starting next year, Medicaid will include a work requirement for many recipients in most states. While most people with PH likely would be exempt, it’s important to make sure your contact information and other paperwork is current.

Depending on each state’s rollout schedule, letters explaining these changes should go out by the end of September, said Jaeger Spratt, PHA’s advocacy and treatment access program manager.

Implementation of the work requirements will vary widely among states. Anyone who receives Medicaid benefits or is considering applying for coverage should read up on the changes in their state, Spratt said. “We don’t want anyone to be surprised,” they said.

New work requirement

Nondisabled adults who receive Medicaid benefits must complete 80 hours of paid work per month under the new law. Recipients also can fulfill the requirement by going to school, attending job training, volunteering, caregiving or a combination of those activities.

Groups exempt from work requirements include children, adults with disabilities, people over 65, pregnant and postpartum people, caregivers, people with medical frailty/complex health needs, and people receiving Social Security benefits. See the full list of exemptions.

‘Pay attention to the mail’

Currently, the definition of “medical frailty” is under debate. And given how quickly the changes are rolling out, there may be errors or oversights, including for people with PH, Spratt said.

“Even if people fall into one of the many exemption categories, they should still pay attention to the mail and respond immediately to any letters or packets from Medicaid,” Spratt said. “You might need to prove your exemption status with a doctor’s note or other paperwork.”

“Self-attestation” of medical frailty will still be accepted in 2027.

“In this first year, people can just check a box on their paperwork to say, ‘Yes, I’m medically frail,’” Spratt said. But starting in 2028, people will likely need to provide documentation.

Medicaid by many names

Some people don’t realize they have Medicaid because it goes by different names depending on the state. For example, in California, it’s called Medi-Cal, while in Washington it’s called Apple Health.

Spratt urges PH patients and caregivers to double-check what type of insurance they have. “Too often, people find out at the pharmacy counter that they’ve lost coverage,” they said.

Possible state budget cuts

The changes coming to Medicaid include cuts to federal funding of state Medicaid programs. How states will respond remains to be seen, Spratt said.

“We hope to know more closer to the end of the year,” they said. “Keep an eye out for updates.”