Medicaid
KFF: big federal Medicaid changes are coming, and Medicaid is a midterm issue
New federal work requirements start by January 1, 2027 for some working-age adults — most people 65 and older are not in that group. KFF explains what changes, what doesn't, and why states' budgets could still affect care for older adults.
Key facts
- KFF published an October 21 update on Medicaid changes from the 2025 federal law.
- Starting by January 1, 2027, 44 states including D.C. must begin work requirements for adults in the ACA expansion group.
- Most people 65 and older are not in that group.
What happened
KFF published an election update on October 21 on Medicaid changes from the 2025 federal reconciliation law. When the law passed, the Congressional Budget Office estimated its Medicaid changes would cut federal Medicaid spending by $911 billion from 2025 to 2034 and raise the number of uninsured people by 7.5 million.
Starting January 1, 2027 or earlier, 44 states including D.C. must start work requirements for adults in the ACA expansion group or certain waiver programs. The law also limits how states raise Medicaid money through provider taxes. KFF says 4 in 10 voters call it "extremely important" for candidates to discuss Medicaid's future.
What it means for families
The work rules apply to working-age adults in the expansion group, not most older adults on Medicaid. But tighter state budgets can affect provider payments and the home and community services older adults use, and adult children on Medicaid may be affected themselves.
For example: a daughter in her 50s who works part-time and is on Medicaid while helping her mother at home may need to show she meets the work rule, or qualifies for an exemption, when she renews. Her mother, at 80, is not in the group the work rule applies to. The family's risk is the daughter's coverage, not the mother's.
What this means in New York: NY State of Health says some adults ages 19 to 64 will have new work requirements that are checked when they apply or renew. Older New Yorkers getting Medicaid for long-term care should still watch their mail, because missed renewal notices are a common way coverage stops.
Quick answers
When do the new federal Medicaid work requirements start?
Starting January 1, 2027 or earlier, 44 states including D.C. must start work requirements for adults in the ACA expansion group or certain waiver programs. The law also limits how states raise Medicaid money through provider taxes. KFF says 4 in 10 voters call it "extremely important" for candidates to discuss Medicaid's future.
What to do this week
- If a family caregiver in your household is on Medicaid and age 19 to 64, check whether the new work rules apply to them.
- Make sure the state has a current mailing address for everyone on Medicaid so renewal notices aren't missed.
- Read the KFF summary linked below for a plain overview.
- If someone in the family is 19 to 64 and on Medicaid, write down their next renewal month and set a reminder a month before it.
Sources
More from Medicaid
- Judge blocks stricter 'medically frail' test in Medicaid work rules
- Medicare proposal could cut off remote monitoring for many patients, especially in rural areas
- First study of Medicare's prior authorization pilot finds use of targeted services fell