Medicaid is a need-based government insurance program. Despite being funded largely by the federal government, Medicaid programs exist on a state-by-state basis. Every state has its own rules, but those rules must align with certain federal regulations.
Key rules regarding Medicaid eligibility are set to change in 2027. After the federal government passed the 2025 budget reconciliation act, also known as the One Big Beautiful Bill, major changes to existing laws and programs are underway. Sweeping changes to multiple different federal programs and policies are set to take effect on January 1st, 2027.
Medicaid is one of the programs subject to new restrictions. People who may need Medicaid for in-home health support, long-term rehabilitation care or nursing home assistance may find that they have a harder time qualifying for Medicaid and keeping their benefits once the new rule takes effect.
What eligibility rules changed?
As mentioned above, every state currently has unique policies regarding Medicaid eligibility. In New York, for example, there are income limits based on family size and the age of the applicant.
Some states already impose work requirements. The changes to Medicaid eligibility slated to take effect in 2027 make work requirements mandatory in all states. Beginning in 2027, Medicaid recipients and applicants must meet a federal work requirement. The language within the law itself refers to this as a “community engagement requirement.”
Medicaid recipients need documentation of at least 80 hours per month engaging with their community. The law considers gainful employment, volunteering or studying in a school as forms of eligible community engagement. Not only do Medicaid recipients need to prove that they meet the standard when they apply, but they also need to submit paperwork every month affirming that they have met the 80-hour requirement.
The law applies to applicants up to the age of 64, with exceptions for those acting as a caregiver for a disabled relative and those with especially disabling medical conditions. Older adults in need of long-term care benefits may be able to bypass this requirement. Spouses of older individuals acting as caregivers could also theoretically qualify for Medicaid without meeting the community engagement requirements due to their full-time caregiver status.
Those concerned about these changing rules may want to consider applying in advance before they take effect. The sooner people submit paperwork and prove that they qualify for Medicaid, the easier it may be for them to learn about eligibility requirements and meet them to maintain their benefits.
Reaching out to the team at the Law Offices of Polizzotto & Polizzotto, LLC, can help those in need of elder law services, including Medicaid planning and application assistance. People intending to apply may also want to review the FAQ on our website to learn the basics of this situation so that they feel more comfortable asking informed questions of our team.
