How & When the Big Bill Will Affect Your Medicaid Benefits

The recent passage of the One Big Beautiful Bill Act has made sweeping changes to the future of Medicaid. While many of these changes won’t take effect right away, it’s important to understand what’s coming so you can prepare.

Here’s a clear breakdown of what to expect—and when.

More Red Tape

Two highly anticipated rules that would’ve made it easier to apply for benefits have been postponed until at least September 30, 2034:

• Medicare Savings Program Simplification: This rule aimed to streamline enrollment into programs that help pay Medicare premiums and other costs. It has been delayed more than a decade.
• Medicaid and CHIP Coordination: This rule would’ve simplified applications and transitions between Medicaid, CHIP, and related programs. It’s also on hold until at least late 2034.

These delays mean that the current barriers to accessing and navigating these programs will remain for the foreseeable future.

Procedural Changes

In reduce the amount of alleged abuse in the program, the new bill also sets deadlines and procedural checks to ensure that strict standards are upheld.

• Starting January 1, 2026, all Medicaid enrollees will need to recertify their eligibility every 180 days (6 months). This could increase paperwork burdens for individuals and administrative costs for states.
• Starting October 1, 2026, stricter rules for immigrant beneficiaries will begin to be enforced. To be eligible, an individual must be a US citizen or national, or a lawfully admitted alien, or someone who meets other specific immigration criteria.
• Starting January 1, 2027, states will begin checking the Death Master File on a quarterly basis to ensure that anyone who dies is removed from Medicaid rolls promptly.
• Starting January 1, 2028, Medicaid will require states to disenroll deceased providers and suppliers quarterly as well.
• Starting October 1, 2029, states will start verifying enrollee addresses more frequently to ensure that people receiving Medicaid live where they say they live.

Work Requirements

New work requirements will be required for Medicaid no later than December 31, 2026. That means they could and likely will begin before that time.

Adults affected by this change will need to meet one of the following standards to maintain Medicaid coverage:

• Work at least 80 hours per month
• Volunteer for 80 hours per month
• Participate in a work training program for 80 hours/month
• Enroll at least half-time in an educational program
• Combine any of the above activities to reach 80 hours
• Earn income equal to at least 80 hours of minimum wage/month
• Be a seasonal worker with a 6-month average income at that level

There are some exemptions to these rules, but the exemptions are more limited than they have been in the past. For example, the new work requirement will not apply to those who are:

• Individuals under age 19
• Medicare Part A or Part B enrollees
• Pregnant and newly postpartum women
• People undergoing drug/alcohol treatment or rehab
• Caregivers of children under 14 or disabled family members
• Those recently released from incarceration (within the past 3 months)
• Native Americans and Alaska Natives (including Urban and California Indians)
• Medically frail individuals (blind, disabled, suffering from substance use or severe mental health issues)
• Veterans with a 100% disability rating

There may also be exemptions for temporary hardship (such as a hospitalization), people in declared disaster areas, and those who have to travel outside their community for an extended period of time due to health care reasons. However, it appears those exemptions may be optional.

Expanded Home Care Services

Starting July 1, 2028, states will be able to offer more flexible access to in-home services like home aides, adult day care and other non-institutional support.

This will benefit people who don’t meet strict nursing home requirements but still need assistance.

States must define their own eligibility criteria, which could vary.

New Cost Sharing Requirements

Starting October 1, 2028, new cost sharing requirements will go into effect. This means that some low-income adults will begin paying copays if they gained coverage under the Medicaid expansion and have an income that is above 100% of the federal poverty level.

Under the rules, States can only apply copays for non-essential services. That means that you cannot be charged for primary care, emergency care, mental health treatments, substance abuse treatments, pregnancy care or services at rural or low-income clinics.

However, you may have to pay a copay for services at other providers. The copays cannot exceed $35 per service or item. The total amount you are charged cannot exceed 5% of your family’s income in any month or quarter, either.

New Rules for Medicaid Projects

Going forward, any new Medicaid demonstration projects must be budget neutral, meaning they cannot cost the federal government more than traditional Medicaid would. This policy aims to limit cost overruns and enforce fiscal discipline on state-run Medicaid innovations.

This may impact more innovative programs, like the ones that have paid for air conditioners and other essentials in the past.

Relief Recap

These changes represent a massive shift in Medicaid policy over the coming decade. While some of the most restrictive elements—like work requirements and cost sharing—take effect sooner, the most helpful improvements have been delayed significantly.

Be sure to stay informed, track your eligibility, and prepare documentation early to avoid coverage interruptions. Subscribe or follow us for updates as these policies develop and deadlines approach.