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Provider News Digest

2026 eligibility changes for Medicaid members


On July 4, 2025, H.R. 1, also known as the One Big Beautiful Bill Act (OBBBA), was signed into law. H.R. 1 changes how some Medicaid members qualify for and keep their Medicaid coverage. Most of these changes affect adults covered through Medicaid Expansion. Some immigrant groups that were previously eligible for Medicaid may no longer qualify.

Many of these changes will begin taking effect in late 2026 and will be phased in over several years. Review the information below to learn the timeline of changes, what you can do now, training available, and how to best support your Medicaid patients as changes continue.

Timeline of changes

Date
Policy Change
Impact Summary
November 1, 2025
(in effect)
ACA Tax Credit Expiration
Increased premiums for ACA plans.
October 1, 2026
Qualified Immigrant Eligibility Restrictions
Medicaid eligibility generally limited to US citizens, US nationals, green card holders, people from Cuba or Haiti, COFA migrants.
January 1, 2027
Work/Community Engagement Requirement
Show 80 hours of working, schooling, job training, and/or volunteering. Or qualify for an exemption.
January 1, 2027
6-Month Redeterminations
Some members will have to renew Medicaid benefits every 6 months. Previously it was 1 year.
January 1, 2027
Retroactive Coverage Reduction
1-month retro window.
January 1, 2027
Native Indian/Alaskan Native Verification
Must verify status to qualify for exemptions.
2026-2028 phased
State Directed Payment Caps
Hospital state directed payments to 100% of Medicare rates.
October 1, 2028
Cost Sharing for Expansion Adults
Up to $35/service for adults >100% FPL.

 

Earliest upcoming change: Qualified immigrant status

Of the changes ahead, the qualified immigrant eligibility restrictions will take effect first. With this change, some groups that used to be eligible for Medicaid may not qualify anymore under the new law. This includes refugees and asylees, humanitarian parolees, and survivors of trafficking or domestic violence.

Starting October 1, 2026, Medicaid will mostly be for:

  • U.S. citizens and U.S. Nationals
  • Green card holders (Lawful Permanent Residents) who have been in the U.S. for 5 years or more
  • People from Cuba or Haiti who entered under special rules
  • COFA migrants (citizens of Marshall Islands, Micronesia, or Palau)
    • Note: Children and pregnant people may still be able to get health insurance even if the rules for others have changed.

Action to take now: Provide care to patients who might lose coverage

The most important action you can take now is to proactively provide care to patients who might lose their Medicaid coverage in October. We suggest you see these patients for office visits as soon as you can, as well as help them get their prescription refills early.

It’s also a good idea to give your office staff a list of free or low-cost clinics. This way, you can help your patients find a new place for care if their plan ends. 

 

What should I tell my patients?

  • Make sure their information is up to date: Reiterate that they need to watch their mail and keep their contact information (email and mailing address) current. The Department of Workforce Services (DWS) will send a letter or email if more information is needed to keep coverage, or if their coverage has been terminated.
  • Refer pregnant members to DWS: Some pregnant Medicaid members may lose coverage during their pregnancy or postpartum. Please direct them to DWS to request Emergency Medicaid coverage for delivery. Department of Workforce Services: 866-435-7414.
  • Refer to the website: Direct them to obbba.medicaid.utah.gov for the most up-to-date information.

Attend the 2026 Statewide Provider Training Webinar

Providers can register for the 2026 Statewide Provider Training, a webinar offered by Utah Medicaid that will provide a full overview of the H.R. 1/OBBBA provisions and the upcoming changes resulting from the bill.

The webinar will be held on Thursday, September 17th, from 10:00 AM to 11:00 AM. Following the presentation, there will be a Q&A session. All providers and community stakeholders who work with our members are encouraged to attend.

If you are unable to attend, slides and recordings of the training will be posted on Utah Medicaid’s website.


REFERENCES

  1. United Way of Utah County. “Printable Resource Lists.” 211 Utah. Accessed August 12, 2026. https://211utah.org/printable-resource-lists/.
  2. Utah Department of Health and Human Services. Medicaid Eligibility Changes for Immigrants. 2026.
  3. Utah Department of Health and Human Services. “OBBBA Medicaid Updates.” Utah Medicaid. Accessed August 12, 2026. https://obbba.medicaid.utah.gov/.
  4. U.S. Congress. H.R. 1—One Big Beautiful Bill Act. Congress.gov. Accessed August 13, 2026. https://www.congress.gov/bill/119th-congress/house-bill/1/text.