Here's what is happening, how it affects your practice, and what you can do now.
What are the new Medicaid work requirements?
Starting January 1, 2027, many adults on Medicaid must show they work, go to school, do job training or volunteer for at least 80 hours a month.
Who it affects: mainly working-age adults (19 to 64) who got Medicaid through their state's expansion.
Who is exempt: examples include pregnant women, parents and caregivers of young children, and people who are medically frail or disabled.
More paperwork: many of these adults will also have to renew their coverage every 6 months instead of once a year.
Five governors have asked the federal government to delay the rule, but for now the January date stands. One survey found nearly half of Medicaid members aren't ready. New Hampshire alone expects up to 29,000 people to lose coverage by 2028.
How this affects your practice
Patients may lose coverage without knowing it. Many will find out at your front desk.
More uninsured and self-pay patients, especially in early 2027.
More denied claims if you bill Medicaid for someone whose coverage just ended.
Missed care. Patients who lose coverage often skip visits, then come back sicker.
What to do now: 5 simple steps
How to turn this into an opportunity
Build loyalty.
Practices that help patients keep coverage keep those patients, and keep getting paid.
Fewer write-offs.
Catching a lost coverage at check-in avoids a denied claim months later.
Self-pay packages.
Simple, clear prices for common visits keep patients coming to you even without coverage.
Key dates
| Date | What happens |
|---|---|
| Now | Warn patients and prepare your front desk |
| January 1, 2027 | Work requirements start in most states |
| During 2027 | Many expansion adults renew every 6 months |
The bottom line
Warn your Medicaid patients now, help those who qualify for exemptions, and check eligibility at every visit in 2027.
Frequently asked questions
Who has to meet the Medicaid work requirements?
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Mainly adults aged 19 to 64 who got Medicaid through their state's expansion. They must show 80 hours a month of work, school, job training or volunteering.
Who is exempt from the Medicaid work requirements?
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Examples include pregnant women, parents and caregivers of young children, and people who are medically frail or disabled. Each state sets the exact process, so patients should check with their state Medicaid office.
How can my practice help patients keep their coverage?
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Tell patients about the rule early, help those who may be medically frail or disabled document it, and point everyone to their state Medicaid office.
Is the January 2027 date final?
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For most states, yes. A few states may get extra time, so check your state Medicaid agency's website.
Feeling overwhelmed? HealthRescue Partners can help
If you're not sure how these rules will affect your patients or your revenue, HealthRescue Partners can help. We can:
- Explain the new Medicaid rules in plain terms
- Give you patient-friendly handouts and a front-desk eligibility guide
- Help you plan for patients who lose coverage
Sources
- Blue states ratcheting up bid against Medicaid work requirementsBloomberg Law, Oct 16, 2026
- Up to 29,000 in NH could lose Medicaid coverage by 2028NHPR, Oct 20, 2026
- Nearly half of Medicaid members unprepared for 2027 work requirementsAeroflow Health survey, Oct 20, 2026
- Washington hospitals anticipate losing billions from Medicaid cutsThe Columbian, Oct 21, 2026
This article is general information, not legal or billing advice.