Upcoming Medicaid Changes: What Families Need to Know
The recent signing of the One Big Beautiful Bill Act introduces significant changes to Medicaid that may affect you or someone in your household. These updates include new eligibility requirements, reduced retroactive coverage, and changes to who qualifies for certain benefits. We understand these changes can feel overwhelming, so we’ve broken them down below to help you stay informed and prepared.
1. Stricter Work Requirements
Nonexempt adults enrolled in Medicaid will now need to demonstrate at least 80 hours of work per month. These hours will be verified by the state during eligibility redeterminations, which will now occur at least twice a year, rather than just once annually. This requirement is expected to be implemented sometime before 2027.
2. Introduction of Co-pays
Another upcoming change is the introduction of co-pays for some adults who gained coverage under Medicaid expansion. Starting October 1, 2028, enrollees may be charged up to $35 per service. However, there are important exemptions: prescription drugs, primary care visits, and services provided by rural health clinics will not require co-pays.
3. Reduced Retroactive Coverage
Currently, Medicaid can cover up to 90 days of medical services prior to the application date. Beginning January 1, 2027, this will be shortened to one month for adults in the Medicaid expansion population and two months for those outside that group. If you're someone who applies after an unexpected medical emergency, this change could have a major impact.
4. Lower Home Equity Limit
Starting January 1, 2028, the maximum home equity limit for individuals applying for long-term care services through Medicaid will be capped at $1 Million, with no adjustments for inflation.
5. Changes to Immigrant Eligibility
Beginning October 1, 2026, Medicaid eligibility for certain immigrant groups will change. Refugees, individuals granted asylum, certain abused spouses and children, trafficking survivors, and others who were previously covered under humanitarian protections will no longer be included in the list of qualified immigrants.
If you’re currently enrolled in Medicaid or think you may need to apply in the future, now is a good time to connect with your Medicaid case worker or manager. They can help you understand how these changes apply to your specific situation and prepare you for upcoming deadlines.
BOOST is here to support you with information and resources, but the best source for questions about your Medicaid coverage will always be your assigned case worker. Stay informed, stay proactive, and know that you are not alone.
Want more tips like these? Stay connected with us for practical ideas and real-life resources by following us on Facebook and Instagram. You can also reach out to our Director of Teacher Success Whitney Carper at wcarper@boostbyhinge.org for more help navigating personal financial challenges.