What’s changing with Medicaid in 2026?

Several changes are coming to Medicaid in 2026 that will affect how you keep your coverage active, how often you need to renew, and who qualifies.

Not all of the new rules will kick in at once, so it’s important to stay on top of the timelines. New immigrant eligibility rules start in October 2026, for example, while new Medicaid work requirements (called “community engagement”) start in January 2027 in most states, although some started earlier.

Make sure your state Medicaid office has your current mailing address and contact information so you never miss a notice about renewals and work requirements. Here’s what else you should know to stay prepared.

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What are the new rules for Medicaid in 2026?#what-are-the-new-rules-for-medicaid-in-2026

1. Work or community engagement requirements#1-work-or-community-engagement-requirements

Starting in 2027, most adults ages 19 to 64 will need to show that they’re working or participating in approved activities, like education or volunteering, to keep their Medicaid coverage (this is similar but separate from the updated SNAP work requirements).

You'll need to complete at least 80 hours of those qualifying activities per month (you can combine them too, so working and going to school counts too) or earn at least $580 in monthly income in order to meet the requirements.

2. More frequent renewals#2-more-frequent-renewals

If you're in the Medicaid expansion group (which covers adults with incomes up to 138% of the federal poverty level), you'll need to renew your coverage every six months instead of every year starting in 2027. The timeline depends on when you applied or last renewed.

• If you applied for Medicaid before January 1, 2027, or renewed before March 1, 2027, you'll get 12 months of coverage if you're eligible. After that, you'll renew every six months.
• If you apply for Medicaid after January 1, 2027, or renew after March 1, 2027, you'll renew every six months if you still qualify.

3. Limited retroactive coverage#3-limited-retroactive-coverage

Previously, you could get up to 90 days of retroactive coverage after being approved for Medicaid—that means you could get medical bills covered up to three months before your coverage starts.

Starting in 2027, the amount of backdated coverage will be limited. Most adults will get one month of retroactive coverage for medical expenses before your application date. Children, seniors, people with disabilities, and pregnant people will get two months.

4. Restrictions on immigrant eligibility#4-restrictions-on-immigrant-eligibility

Some specific categories of immigrants will no longer be eligible for Medicaid starting in October 2026. Before the change, qualifying groups of immigrants included:

• Lawful permanent residents (Green Card holders)
• Refugees
• Parolees and asylees
• Domestic violence survivors
• Trafficking survivors
• Cuban and Haitian entrants
• Citizens of the Freely Associated States (COFA)
• Lawfully residing children and pregnant adults (CHIPRA 214)

As of October, refugees, parolees, asylees, and domestic violence and trafficking survivors will no longer be eligible for Medicaid. If you're an immigrant, check with your state Medicaid office to confirm your eligibility status.

Who will be affected by the new Medicaid rules?#who-will-be-affected-by-the-new-medicaid-rules

Here’s who needs to be aware of the new changes to Medicaid:

• Adults ages 19 to 64 who aren’t exempt from work requirements: If you're between 19 and 64 and don't fall into one of the exempt categories, you'll need to meet the work requirement starting in 2027.
• Expansion adults with new renewal timelines: If you're part of the Medicaid expansion group (adults with incomes up to 138% of the federal poverty level), you'll be renewing more often. This means more paperwork and deadlines to keep track of. Mark your calendar for renewal dates.
• New applicants who will get less retroactive coverage: If you apply for Medicaid, you'll get less coverage for medical expenses that happened before your application. This matters most if you have unpaid medical bills from before you applied.
• Certain immigrants: Refugees, parolees, asylees, and domestic violence and trafficking survivors will lose coverage later this year.

Who’s exempt from Medicaid work requirements?#whos-exempt-from-medicaid-work-requirements

There are two groups of people who don't have to meet the new Medicaid “community engagement” requirements.

Group 1: Permanently exempt#group-1-permanently-exempt

You're permanently exempt from Medicaid work requirements if you get SNAP or TANF and are already meeting those work requirements, or if you fall into any of these other categories:

• Under 18 or 65 and older
• Currently pregnant or pregnant in the last 12 months
• Enrolled in Medicaid because of a disability
• Diagnosed with a physical or mental health condition that makes it hard to work
• Entitled to Medicare Part A or enrolled in Part B
• Parent, guardian, or caregiver to a child under 14
• Parent, guardian, or caregiver to someone with a disability
• Currently in foster care, or under 26 and formerly in foster care
• American Indian or Alaska Native
• Veteran with a total disability rating
• In drug or alcohol rehabilitation
• Currently incarcerated or formerly incarcerated and released in the last 90 days

Group 2: Temporarily exempt#group-2-temporarily-exempt

You'll get a short-term exemption from the Medicaid work requirements (just until your next renewal) if you're in any of these situations:

• Currently receiving inpatient care in a hospital (including psychiatric), nursing facility, intermediate care facility, or other similar services
• Living in a county with a federally declared disaster or emergency
• Living in a county with a high unemployment rate (at least 8% or 1.5 times the national rate)

If you qualify for an exemption, you'll need to show proof at the time you apply or renew for Medicaid. Some exemptions (like medical frailty) may require a health screening, or documented proof that you can’t work.

For pregnancy, you can simply declare it at application. For temporary exemptions, your state will verify your circumstances when you renew.

What do I need to do to meet Medicaid work requirements?#what-do-i-need-to-do-to-meet-medicaid-work-requirements

You can meet the 80-hour monthly requirement for Medicaid through any combination of these activities:

• Paid employment of any type
• Community service (unpaid volunteer work, job training, or work programs)
• Education (at least half-time enrollment)
• Seasonal work (if your average monthly income over the last six months equals $580)
• A combination of any of the above

You don't have to work traditional hours in order to qualify. As long as your activities (work, school, or volunteering) add up to 80 hours per month (or $580 in earnings), you're meeting the requirement.

If you need to meet the new Medicaid work requirement, start tracking your hours or income now.

Get written documentation from supervisors or work contacts for hours you complete. You'll need this when you renew or if your state asks for proof. Save receipts or letters showing your work or volunteer activities.

Who is most likely to lose Medicaid?#who-is-most-likely-to-lose-medicaid

If you're between 19 and 64, don't meet the work requirements, and don't fall into an exempt category, you're at risk of losing your Medicaid coverage.

If your state sends you a notice saying you don't comply with the new Medicaid requirements, you'll have 30 days to show you're meeting them or prove you qualify for an exemption.

If you don't respond with documentation of work hours or proof of an exemption, your Medicaid coverage will end.

With more frequent renewals (every six months instead of yearly), there are also more opportunities to miss a deadline. If you don't renew in time, you could lose coverage. Check your mail regularly for renewal notices and mark your calendar with renewal dates.

People with temporary exemptions won't lose coverage until their exemption ends. As long as you renew on time and provide any required documentation, you can keep your coverage.