Beginning January 1, 2027, new federal requirements—primarily stemming from the OBBBA/2025 Reconciliation Bill—will require most "able-bodied" Medicaid expansion adults (ages 19-64) to work or participate in community engagement activities for at least 80 hours per month to maintain coverage. Exemptions include caregivers, the medically frail, and pregnant individuals.
Beginning January 1, 2027, OBBBA requires adults covered under the Medicaid expansion population to participate in mandatory work activities or show they are exempt.
The 2025 budget reconciliation bill (H.R. 1), signed into law on July 4, 2025, introduces new work requirements, also referred to as community engagement requirements, for certain Medicaid enrollees. The provision makes continued Medicaid eligibility contingent upon participation in work or other qualifying activities.
Fiscal incentives to expand Medicaid will end. Increased costs for Affordable Care Act (ACA) marketplace enrollees. Medical students will have fewer options to pay student loans.
Effective June 2025, federal regulations no longer require Medicaid applicants to apply for other benefits (including retirement and disability benefits) in order to be eligible for Medicaid.
Polls show many in the population believe Medicaid is an unaffordable/unnecessary government entitlement program that benefits those not eligible and those who elect to forego purchasing coverage for themselves and their families.
One likely reason fewer doctors accept Medicaid patients is that those claims are paid at a lower rate than other insurance. More providers would be interested in Medicaid if the program's reimbursements were similar to Medicare payments, according to the report.
The Centers for Medicare & Medicaid Services (CMS) has set the standard monthly Part B premium at $202.90 in 2026, an increase of $17.90, or just under 10 percent, from the 2025 premium of $185.00.
Residents of states that accept the Medicaid expansion will still face challenges in accessing needed services due to important deficiencies in essential health benefits, financial strain resulting from cost-sharing provisions targeted at Medicaid beneficiaries, and decreased access to specialists relative to those ...
1, states will be required to impose work requirements on working-age adults (ages 19 to 64) in states that have expanded eligibility for Medicaid coverage. Enrollees subject to work requirements must prove that they are performing 80 hours of work, or another approved activity, each month.
9. Not Financially Eligible. An applicant must meet the Medicaid resource and income limits and guidelines set by their state. Resources and income above the state limits may disqualify the applicant.
They will check when you submit an application and on an annual basis, but checks can occur at any time. While agencies can look at account balances, they can't view your personal bank statements. Other information used to determine Medicaid eligibility often comes from public records.
Not every state is cutting Medicaid yet, but they eventually will. Most of the provisions in the 2025 budget reconciliation bill—HR 1—have yet to go into effect and these cuts will have a devastating impact on state budgets. KFF analysis shows that HR 1 will cut federal Medicaid spending by $1 trillion over ten years.
The largest source of the Medicaid cuts, accounting for 5.3 million fewer enrollees according to CBO, stems from a provision in the budget law that compels people enrolled through the ACA Medicaid expansion to meet new work requirements with onerous reporting and administrative burdens.
It takes some financial planning. The second downside is that it restricts you to where you can go live. If you need nursing home care, you can only go to the places that accept Medicaid as a benefit.
This means earning sufficient income to offset expenses. “Expenses for most physicians have increased enormously in recent years, owing largely to burdensome regulations,” Sade argues. When uncovered costs become too great, physicians are ethically justified in refusing to accept Medicaid patients, according to Sade.
In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)
If you qualify for Medicaid, most of your Social Security income will go toward paying for the cost of your care. However, Medicaid ensures that you won't be left without resources by allowing certain deductions, so you can still meet essential personal and living expenses.
Effective January 1, 2026, adults 19 or older, not pregnant and undocumented or without satisfactory immigration status, will no longer qualify for full-scope Medi-Cal coverage if they apply for benefits on or after January 1, 2026.
According to Medicare, an inpatient admission is generally appropriate when you're expected to need 2 or more midnights of medically necessary hospital care. Your doctor must order the hospital admission, and the hospital must formally admit you to be considered an inpatient.