Explainer: What’s changing in Medicaid and what can you do?

This article was originally published Sept. 30 and updated Nov. 6

If you or your children get health insurance through Medicaid, or a program in your state that requires an income below a certain amount, you might have heard about big upcoming changes. 

Will those changes affect you? 

Could you lose your coverage, and access to your doctors, medicines and other kinds of care? 

Do you have to work, get a letter from your doctor, or do something else to keep your coverage?

The answers to these questions depend on your specific situation, and what state you live in.

In fact, as of early November 2026, some of the details still aren’t worked out in every state. 

A recent court ruling, and the results of the recent elections for Congress and state legislatures, might mean some of the new Medicaid rules could change in the future. 

But right now, it is important to be prepared to follow the rules as they stand right now, based on the law passed in 2025 and guidance issued by the federal government.

What experts say

In all, 73 million people in the United States have coverage through some form of Medicaid.

That includes 1.8 million Michiganders, or about 1 in 5 people living in the state.

Many people with Medicaid come to University of Michigan Health’s hospitals and clinics to get their care.

Some of them travel hundreds of miles to get specialized care for themselves or their children at U-M Health locations. 

That’s why Alena Hill and her team are tracking Medicaid changes closely.

Her team of Patient Financial Counselors advises U-M Health patients on insurance issues, and on financial assistance for costs that insurance doesn’t cover. 

“Because the Medicaid changes are new, we are still learning details about how the state and federal government will put them into effect,” said Hill, whose team covers U-M Health clinics and hospitals from Ann Arbor and southeast Michigan to the Lansing and Grand Rapids areas.

“The good news is, we have staff from the Michigan Department of Health and Human Services (MDHHS) Medicaid team working directly with us in all three of our offices, so we’re getting the latest updates.” 

She and her team welcome inquiries from U-M Health patients, and others, with Medicaid coverage.

Anyone can contact the patient financial counseling teams at the U-M Health main medical campus in Ann Arbor, the UM Health-Sparrow office in Lansing, or the UM-Health West office near Grand Rapids, even non-patients. 

MDHHS also has a way for Michiganders to find local assistance on its site. In other states, the United Way's 211 nationwide information service can refer anyone to a local organization or agency that can assist.

U-M Health primary care physician John Ayanian, M.D., M.P.P., has special interest in the new changes. 

In addition to seeing adult patients in Ann Arbor, he helps lead research on the impact that Medicaid has had, including a recent report about what happened after Michigan expanded Medicaid in 2014 to cover more people under the Healthy Michigan Plan. 

“Our research has shown the importance of this coverage for the health of individuals who have it, and also for the hospitals and clinics that serve everyone in Michigan, with any kind of insurance,” said Ayanian, who is a Professor of Internal Medicine, Public Health and Public Policy at U-M.

“With Medicaid eligibility changes starting in October 2026 and January 2027, it’s important that we work together to help people keep their coverage if they are eligible.”

The most important thing to do if you or your children have any form of state coverage

No matter what state you live in, Hill says, make sure your contact information is up to date with your state’s computer system.

Be sure to update it if you move, or you change your phone number or email address.

In Michigan, the system is called MiBridges.

If you already have an account, take a minute to log in now through your phone, or through a computer or tablet at home or a public library. 

Make sure the MiBridges system (or your state’s system if you live outside Michigan) has your current phone number, mailing address, home address and email address.

If you don’t have an account, this is a good time to create one. 

Need help? If you live in Michigan, call 1-800-642-3195 or email [email protected].

If you live in another state, find contact information for your state Medicaid agency on this map.

By keeping your contact information up to date, you won’t miss an email, letter or text message with important information or deadlines. 

If you get a letter, email message or text message from your state, read it carefully. If it tells you to do something, follow the instructions and obey any deadlines. 

If you get messages, or see ads or social media posts from other sources telling you to do something, be careful. 

It might be a scam, or someone trying to charge you money for something that you can do for free. 

Medicaid changes that start January 1, 2027:

(For information about changes that began October 1, 2026 for certain legal immigrants, see further down in this article)

For anyone joining or rejoining a state plan, or who has a low income but is uninsured: 

A rule change makes it important to get coverage now, or finish any enrollment process that may be in progress. 

The change affects what's called a "lookback period." When someone joins a state Medicaid plan of any kind, the state pays for the health care they received in a time period before their coverage was approved. 

This is because many people who meet the income and other requirements for state coverage start the enrollment process when they get a new health diagnosis, suffer a health emergency, or experience a life change such as becoming pregnant or losing a job. They often get care while the state processes their application for coverage. In Michigan, it can take 45 to 90 days to complete the approval process for the state's programs for children and adults, though emergency approvals are possible.

The time periods for this lookback coverage will get shorter in 2027. After someone's coverage gets approved, the state will only be able to cover the cost of the care that happened during the new shorter period. Hospitals and clinics may ask patients to pay for some of the care that happened before that time. 

So if you are uninsured, or your children don't have insurance, or you have started your enrollment but haven't finished, it might be a good idea to apply or finish enrollment in 2026. Check with your state to see what programs they offer.

New requirements for some people to keep Medicaid coverage

There’s a lot of information swirling around about “work requirements” for people with Medicaid. This is part of changes taking effect in January. 

There’s also confusion about what people with health conditions or disabilities, or people who serve as caregivers to children or others, will have to do to meet or be exempt from the new requirements. 

A lot of details still aren’t known as of November 2026. And details will vary by state. 

There may be actions in the courts and Congress in 2027 about this, but until and unless there is a final court ruling or a binding change in the law, the current law is in effect.

“The most important thing to do right now is to figure out what form of Medicaid you have, or what your child or the person you are the caregiver to has,” said Hill, who oversees U-M's patient financial counselors. 

“There are a lot of people who are worried, when in fact they will not be affected," she said. "But for those who will be affected, knowing now is important because you can use this time to prepare.” 

The state of Michigan has established a page about the changes that it will continue to update, and many states have such pages too. But here are the basics:

Who isn’t affected by the Medicaid changes?

• Children with Medicaid, CHIP or other state coverage programs for people under 19
• People over 65 who have Medicaid and Medicare together because of low incomes
• People who have standard Medicaid that is not through a state expansion program (such as the Healthy Michigan Plan) or through what’s called a Section 1115 waiver 

People in these groups will still have to show they are eligible for their plan every year based on income and assets.

But they will not be subject to work requirements or have to prove that they are too sick or disabled to work. 

Who is potentially affected by the changes?

Adults aged 19 to 64 in 44 states who have coverage through a Medicaid expansion plan, such as the Healthy Michigan Plan, or a Section 1115 waiver.

How can you know if you are affected by the changes? 

If you are in Michigan, you can tell if you are in the Healthy Michigan Plan if you see “HMP” when you look at your account in the MiBridges online system. (If you don’t have a MiBridges account yet, it’s important to create one now.) 

The type of Medicaid plan you have also appears on papers you received when you enrolled. 

If you’re not sure, call the number on the insurance card you received from your plan.

Wherever you live, you can contact your Medicaid health plan or state help line to find out whether your coverage means you are in a Medicaid Expansion or Section 1115 plan and will have to meet the new requirements.

What all people in this group will have to do

Everyone in this group will have to submit information every six months to show that they are eligible to continue their coverage based on their income; this is called a redetermination.

Previously, they had to do this once a year.

This requirement is true for everyone with Medicaid expansion or Section 1115 waiver coverage starting in 2027, even if they get an exception to the “work requirement” rule.

What the “work requirement” rule means for people in this group

• They will need to work, or do other activities such as volunteering or going to school or job training, for an average of 20 hours a week, or 80 hours a month, in order to keep their coverage. Or, they can seek an exception (exemption) to this requirement (see below).
• If they don't get an exception, they will have to provide information to show they are meeting this requirement every six months using their state’s system, unless the state can get this information itself. 
• If the state does not receive this information every six months, the state will cut the person off from Medicaid. The state will send communications about this to the person before the cutoff occurs, so it is important to keep contact information up to date.
• If a person is dropped from Medicaid because they did not meet the new requirements, they can appeal or apply to get back in.  

Who will be able to seek an exception (exemption) to the new rules?

The new rules allow exceptions for health, caregiving and other reasons. But people may have to provide information to the state to prove they qualify, in order to keep their coverage, or qualify for new coverage. 

Michigan has a list of the exceptions it will allow. Specifics about how to qualify for an exception will vary by state. 

Exceptions generally include:

• being pregnant or having given birth in the last 12 months
• being in treatment for addiction (also called substance use disorder)
• being a parent of a child age 13 or under, or a caregiver to someone of any age with a disability
• living with a serious physical or mental health condition or a disability
• being a disabled veteran
• being a person who was in foster care as a child and is still under age 26
• having a temporary hardship such as being hospitalized or being in a nursing home, living in a high-unemployment area, or living in a federal disaster area

In Michigan and some other states, the state government will use existing systems such as payroll taxes and medical bills to try to determine if someone is working or studying for enough hours, or has a serious enough health condition or disability, to keep their coverage.

Michigan has made an online tool available to help people understand if they might have to meet work requirements or be eligible for an exception. It does not submit information to the state; it is for informational purposes only. Try it here. 

As of November, details are still being worked out in most states. In many situations, people seeking an exception may have to submit information to the state. 

Michigan will also be able to tell if a person has already qualified for other benefit programs that have work requirements, such as SNAP food assistance of TANF cash assistance.

If they have, the state will count that as meeting the Medicaid requirement.

If you are affected by the new requirement, what happens next?

Each state will be different.

In general, people who already had coverage from a Medicaid expansion plan will have to show they are meeting the new requirements when it’s the anniversary of the day when they first enrolled.

In Michigan, the first people who must meet the requirement will be those whose Medicaid anniversaries are in March 2027. 

For the first time that a person has to meet the new requirements, a sworn statement from the person that they are too ill or disabled to meet the requirement may be enough.

This is called an attestation.

But after that first time, more proof of their health status may be required.

The details of how this will be provided, and who has to provide it, are still being worked out.

It’s important for everyone who has Medicaid expansion coverage to be alert for communications from their state as more details are provided.

What's the relationship between Medicaid and work?

Past research by the U-M team led by Ayanian, and a new report by U-M researchers working with the U-M-based nonprofit called the Center for Healthcare Research and Transformation, shows that most people covered by Medicaid expansion plans already work or do other things that would meet the requirements of the new law. 

A study published last year by the U-M team also showed that having Medicaid coverage helps make it possible for people to work if they have major health conditions, by helping them improve their health.

More recently, a U-M and Mt. Sinai study found that workers with low-to-moderate incomes who have with highly variable weekly work hours, fluctuating annual incomes or employment disruptions were more likely to have Medicaid coverage than coverage from an employer. 

It also found that 70% of those with volatile hours had work schedules that fluctuated below 20 hours per week at some points during the year; 20 hours is the average needed to meet the work requirement for those in Medicaid expansion plans.

Ayanian has called for researchers to study how the new requirements affect large groups of patients, to document the effects of changes in health policy.
 

Changes to Medicaid for immigrants, as of Oct. 1, 2026

Some immigrant groups, including undocumented immigrants, were already ineligible for full Medicaid and for the CHIP program for children in families with low and moderate incomes.

Now, a new change means more types of immigrants aren’t allowed in these programs, though they can still access limited Medicaid coverage for emergencies, pregnancy and some children.

For immigrants in these newly affected groups who currently have full Medicaid, each state will determine who must leave the program. 

If you are one of them, or your child is, you will receive communication from your state; read it carefully. 

If you or someone you know has a life-threatening emergency, or is about to give birth, it is still OK to seek care immediately at a hospital emergency department. Such care is still covered for all immigrants.

Health care providers are not required to report immigrants to immigration authorities.

Which immigrants will still be eligible for full Medicaid or CHIP coverage? 

• Immigrants who have become U.S. citizens through naturalization 
• Lawful permanent residents (Green Card holders) who have met or are exempt from the five-year waiting period rule 
• Cuban/Haitian entrants (this is a term used for benefits; it is different from immigration status)
• Migrants from three small Polynesian nations called the COFA states

Which immigrant groups will no longer be eligible for full Medicaid if they have not achieved Lawful Permanent Resident (Green Card) status? 

• Refugees
• Asylees  
• Lawfully residing immigrant U.S. military service members or veterans and their family members
• Humanitarian parolees who were allowed into the U.S. during the wars in Iraq, Ukraine and Afghanistan
• Other noncitizens who are in the U.S. due to human trafficking, a withholding of deportation, and other specific situations
  
  Note: For full details, consult your state Medicaid office, an immigrant rights center in your state or the table linked from this page maintained by the National Immigration Law Center.

If someone in one of these groups gets removed from full Medicaid, they can receive emergency care in any state under Emergency Services Only Medicaid. 

For immigrants who are pregnant or under 21:

In all states, pregnancy-related services for pregnant or recently pregnant immigrants can be covered under the Maternity Outpatient Medical Services, or MOMS, provision of emergency Medicaid.

The coverage lasts up to two months after giving birth.

In addition, any lawfully residing immigrant who is under age 21, or pregnant, may be eligible for another form of Medicaid coverage if their state offers it, through a program called CHIPRA 214.

Michigan offers this coverage to its residents.

A guide to which states cover children to age 19, and which cover pregnant women and children/young adults up to age 21, is available here; contact your state Medicaid agency for details.

For anyone who loses coverage for any reason:

Hill notes that anyone in the United States for any reason can seek health care through charity clinics that provide free or low-cost care. 

Immigrants and people who formerly had Medicaid coverage may be able to purchase health insurance through healthcare.gov which is also sometimes called the "Obamacare" marketplace or the Affordable Care Act or ACA Marketplace. Some states have their own insurance marketplaces. 

However, there are some new rules that restrict who can get financial help with the cost of buying insurance on these marketplaces. People with incomes below 100% of poverty level may not receive tax credits or subsidies for plans purchased there. Under new rules for 2027, people who lose their Medicaid expansion coverage because they did not meet the work or exemption reporting requirements cannot get financial help, and neither can legal immigrants who are no longer eligible for Medicaid. 

The trained local assisters listed on the healthcare.gov website know the rules; enter your ZIP code to find one in your area.

Some people may also be able to get care through their county, if it offers an option for people with low incomes.

In Michigan this includes options such as the Washtenaw Health Plan for the county that include Ann Arbor, and the Ingham Health Plan for the county that includes Lansing.