Medicaid Changes in 2027: What Animo Sano Patients Should Know

Federal Medicaid rules are changing, and several of the biggest changes start in 2027. If you have Medicaid, you may have already seen ads, news stories, or letters about new work/community engagement requirements and eligibility redetermination guidelines. It’s a lot to sort through.

The most important thing to know first: these changes do not apply to everyone. They mainly affect adults ages 19 to 64 who are enrolled through Medicaid expansion, and many people who are affected may qualify for an exemption. Rules and dates also vary by state.

Below, we explain what is changing, who may be affected, and what you can do now to keep your care running smoothly. For the latest details in your state, visit our Medicaid Updates page.

Quick Summary

What Is Changing: The New Work and Community Engagement Requirement

In July 2025, Congress passed a federal law, Public Law 119-21. You may see it called the One Big Beautiful Bill Act (OBBBA), H.R. 1, or the Working Families Tax Cut, which is the name the Centers for Medicare & Medicaid Services (CMS) uses. Your state may use any of these names, or simply call them “federal Medicaid changes.”

The best-known change is a new work and community engagement requirement. States must begin applying it by January 1, 2027, though some states started outreach or soft launches earlier.

If the requirement applies to you, you will generally need to show one of the following each month:

• At least 80 hours of work, community service or volunteering, school, or a work program, or a combination of these.
• Monthly earnings of at least $580, which equals 80 hours at the federal minimum wage.

How you report, what counts as proof, and how often your state checks are decided by each state. Some states will review information they already have before asking you for anything.

Who May Be Affected

The requirement mainly applies to adults who:

• Are ages 19 to 64.
• Are enrolled in Medicaid through the Affordable Care Act (ACA) expansion group, or through certain state demonstration programs.
• Are not pregnant.
• Do not qualify for an exemption.

It does not apply to everyone with Medicaid. Children, adults 65 and older, and people who get Medicaid through a disability-based program are generally not part of the expansion group.

Exemptions

Federal law sets out groups of people who are exempt, and each state lists them in its own words. Examples include:

• People who are pregnant or recently gave birth.
• People with a disability or who are medically frail.
• Parents and caregivers of children ages 13 and under, or of a person with a disability.
• Veterans with a total disability rating.
• Former foster youth under age 26.
• American Indians and Alaska Natives.

Some states also offer short-term hardship exceptions. The exact list, and the proof your state needs, can differ. Your state Medicaid agency decides whether you qualify.

Mental Health, Substance Use, and Exemptions

Many of our patients have asked whether their mental health care affects any of this.

A serious or disabling mental health condition may be relevant to an exemption. Federal law includes some people with a disabling mental health condition or a substance use disorder in its definition of “medically frail,” and people in substance use treatment may also qualify.

That said, a diagnosis does not create an exemption automatically, and being in treatment does not by itself mean you are exempt. Only your state Medicaid agency can decide whether you qualify and what proof it needs.

If your state sends you a notice about your health or an exemption, follow the instructions in that notice and respond by the deadline. If you have questions about your treatment, please speak with your provider.

Other Medicaid Changes to Know About

The work requirement gets the most attention, but the same law makes other changes. Most of them apply mainly to adults in the expansion group.

More Frequent Renewals

Starting in 2027, many adults in the expansion group will need to renew their Medicaid every six months instead of once a year. More frequent renewals mean more paperwork and more chances to miss a notice, so keeping your contact information current is especially important.

Shorter Retroactive Coverage

Retroactive coverage can pay for care you received in the months before you applied for Medicaid. Beginning January 1, 2027, that window becomes one month for adults in the expansion group. If you think you may need Medicaid, it helps to apply as soon as you can. If you do not have active insurance coverage you will have to pay for your care in full as self-pay.

Eligibility Changes for Some Noncitizens

New federal eligibility rules for certain noncitizens took effect on October 1, 2026. If you have questions about how this affects you, contact your state Medicaid agency.

Copays Starting in 2028

Beginning October 1, 2028, states will charge some expansion adults with incomes above 100% of the federal poverty level small copays for certain services. Federal law excludes mental health and substance use disorder services from this new copay rule. Any copays your state already charges are not changed by it.

What You Can Do Now

You don’t need to wait for a letter to prepare. A few helpful steps:

• Update your contact information: Make sure your state Medicaid agency has your current address, phone number, and email so an official notice doesn’t get missed.
• Open every notice: Watch for mail, email, and texts from your state Medicaid agency, and respond by the deadline shown.
• Keep records: If you work, go to school, or volunteer, many states suggest saving pay stubs, school records, or volunteer logs. Your state will tell you exactly what proof it accepts.
• Learn your state’s rules: Check your state’s section on our Medicaid Updates page.
• Ask early: If something in a notice is unclear, contact your state Medicaid agency right away.

How Animo Sano Psychiatry Can Help

We cannot decide Medicaid eligibility or approve exemptions. Those decisions belong to your state Medicaid agency.

What we can do:

• Share official links and resources for your state.
• Review the coverage information we have on file for you.
• Talk through care options, including self-pay rates and a Good Faith Estimate, if your coverage changes.

If your coverage is changing, please reach out before your next appointment so we can help you plan ahead. If you have a question about your treatment while your coverage is being sorted out, please speak with your provider.

Billing and coverage questions: Email VOB@animosanopsychiatry.com or call 919-391-7202.

Learn more: Self-Pay Rates at Animo Sano Psychiatry

Helpful Resources

• Your state, at a glance: Animo Sano Psychiatry Medicaid Updates
• Federal overview with a state selector: Medicaid.gov: Upcoming Medicaid Eligibility Changes
• For a deeper look: CMS Fact Sheet: Medicaid Community Engagement Requirement
• If you lose Medicaid: You may be able to get coverage through your state’s health insurance marketplace. Most states use HealthCare.gov, and some, such as New York, run their own.

A Final Note

Medicaid changes can feel overwhelming, especially when you are also focused on your health. A few small steps now, like keeping your information current and opening every notice, can help you stay covered. We’ll keep our Medicaid Updates page current as states share more information.

Last reviewed: November 3, 2026. This article is general information, not legal or eligibility advice. Your state Medicaid agency makes all eligibility and exemption decisions.