Medicaid work requirements and accelerated redetermination cycles — proposed under the One Big Beautiful Budget Act (OBBBA) — could affect coverage for millions of adults currently enrolled through Medicaid expansion, according to new research from the Urban Institute. If you or someone in your household relies on Medicaid, understanding what these proposed changes involve and what alternatives may be available to you is one of the most actionable things you can do right now.

What the OBBBA Proposes for Medicaid Expansion

Under current federal rules, Medicaid enrollees in expansion states undergo eligibility redeterminations annually. The OBBBA, as analyzed by the Urban Institute, would introduce two major structural changes:

  • Work requirements: Expansion enrollees (generally adults ages 19–64 without disabilities) would be required to document a minimum number of hours per month in qualifying activities — typically employment, job training, education, or caregiving.
  • Six-month redeterminations: Instead of annual renewals, enrollees would need to verify continued eligibility every six months, doubling the administrative burden on both applicants and state agencies.

The Urban Institute's modeling projects these combined changes could result in substantial enrollment reductions — not primarily because people stop being eligible, but because of what researchers call "administrative churn": coverage losses driven by paperwork failures, missed deadlines, and documentation gaps rather than actual ineligibility.

This is a proposed federal legislative change, not yet enacted law. Program eligibility and availability vary by state, and implementation timelines would depend on Congressional action and state-level decisions.

Who Is Currently Covered by Medicaid Expansion

Medicaid expansion, authorized under the Affordable Care Act (ACA), extends Medicaid eligibility to non-elderly adults with household incomes at or below 138% of the Federal Poverty Level (FPL). As of 2026, 40 states and the District of Columbia have adopted expansion.

States That Have Not Expanded Medicaid If you live in one of the roughly 10 states that have not adopted Medicaid expansion — including Texas, Florida, Georgia, and Wyoming — these proposed federal changes to expansion would not directly affect your state's current Medicaid structure. However, those states have their own eligibility rules, which are often more restrictive.

Who Expansion Currently Covers Expansion Medicaid is designed for working-age adults who fall into what was historically called the "coverage gap" — people who earn too much for traditional Medicaid but too little to afford private insurance. This includes part-time workers, gig economy workers, seasonal employees, and people between jobs.

The Administrative Churn Problem: Why Researchers Are Concerned

The Urban Institute's concern — and the concern of public health researchers broadly — is not that work requirements will identify large numbers of non-working, able-bodied enrollees. Studies of prior state-level work requirement experiments, including Arkansas's 2018 program (later blocked by federal courts), found that the vast majority of affected enrollees were already working, in school, or had qualifying exemptions. The coverage losses came from people who couldn't navigate the reporting system.

Six-month redeterminations compound this risk. Medicaid agencies in many states are still processing backlogs from the post-COVID unwinding period that began in 2023. Adding a second annual renewal cycle would require significant state administrative capacity that many agencies do not currently have.

For enrollees, this means the practical risk is missing a renewal notice, failing to submit documentation on time, or having a life disruption — a move, a job change, a health crisis — coincide with a renewal deadline.

What You Can Do Now to Protect Your Coverage

Regardless of how the OBBBA progresses through Congress, there are concrete steps you can take today.

1. Confirm Your Current Medicaid Status Log into your state Medicaid portal or contact your state's Medicaid agency directly to confirm your enrollment status, your next renewal date, and the contact information on file. Outdated addresses are one of the most common reasons people miss renewal notices.

2. Update Your Contact Information Make sure your state Medicaid agency has your current mailing address, phone number, and email. Many states now send renewal notices electronically. If your information is outdated, you may not receive critical notices.

3. Gather Documentation Now If work requirements are enacted, you will likely need to document qualifying activity. Start organizing records now: - Pay stubs or employer contact information - School enrollment verification - Documentation of caregiving responsibilities (for a child, elderly parent, or person with a disability) - Medical documentation if you have a condition that may qualify for an exemption

4. Know Your Alternatives If Medicaid coverage becomes harder to maintain, other programs may be available depending on your income and household situation:

  • ACA Marketplace plans with premium tax credits: Adults with incomes between 100% and 400% FPL (and in some cases above) may be eligible for subsidized coverage through HealthCare.gov or a state-based exchange. Open enrollment typically runs November 1 through January 15, but Special Enrollment Periods may apply if you lose Medicaid coverage.
  • Children's Health Insurance Program (CHIP): If you have children, CHIP covers kids in households with incomes generally up to 200%–300% FPL depending on the state, even if adults in the household are not eligible for Medicaid.
  • Federally Qualified Health Centers (FQHCs): Community health centers funded under Section 330 of the Public Health Service Act provide primary care on a sliding-fee scale regardless of insurance status. Find a center near you at findahealthcenter.hrsa.gov.
  • Prescription assistance programs: Major pharmaceutical manufacturers operate patient assistance programs for people who are uninsured or underinsured. NeedyMeds (needymeds.org) and RxAssist (rxassist.org) maintain searchable databases.

If You Live in a Non-Expansion State

If your state has not adopted Medicaid expansion, you may still qualify for traditional Medicaid if you are a parent of a dependent child, pregnant, elderly, or have a qualifying disability. Income thresholds vary significantly by state and category. Contact your state Medicaid agency or visit Benefits.gov to learn about programs that may be available in your state.

A Note on Timing

The OBBBA is a legislative proposal. Federal Medicaid policy changes of this magnitude require Congressional passage, presidential signature, and — in most cases — a formal rulemaking process that allows for public comment before implementation. State Medicaid agencies would then need time to build the administrative infrastructure to implement new requirements. This means that even if the legislation passes, immediate coverage loss is not automatic. However, the time to prepare is before changes take effect, not after.

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Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: April 2026