The new federal legislation commonly referred to as the “One Big Beautiful Bill”, signed into law by President Trump in July 2025, introduces additional administrative and compliance requirements that will substantially affect how individuals maintain Medicaid coverage.
Effective July 1, 2027, the new law introduces several major procedural changes. Most notably, it imposes work requirements for certain Medicaid populations — primarily adults aged 19 to 64 in the expansion group, also known as the Alternative Benefits Plan, or ABP — requiring at least 80 hours per month of work, education, or approved activities. While this requirement does not apply directly to most nursing home residents or incapacitated individuals, it will significantly affect family members, including adult children and community spouses, who may rely on Medicaid coverage.
Even more impactful is the requirement for mandatory eligibility re-determinations every six (6) months, replacing the prior annual review standard. This change dramatically increases the administrative burden on Medicaid recipients. Individuals must repeatedly verify income, assets, and (where applicable) work compliance.
The key question is no longer simply whether an individual qualifies for benefits, but whether they can consistently maintain eligibility under heightened scrutiny.