Medicaid work rules begin in January

NORWALK — More than 3,000 Huron County residents were enrolled in a Medicaid coverage group facing new federal work requirements next year, although many may qualify for exemptions. Beginning Jan. 1, 2027, certain adults receiving Medicaid will have to work, attend school or participate in other approved activities to maintain their health coverage. The changes are part of a federal law passed in 2025 and primarily affect adults enrolled through Medicaid expansion, which provides health insurance to qualifying low-income residents. According to figures published by the Health Policy Institute of Ohio, Huron County had about 3,200 residents enrolled in Medicaid expansion coverage, known as Group VIII, based on state data retrieved in February 2025. While the new rules only apply to the expansion coverage group, the county had about 14,300 Medicaid recipients overall, representing nearly one in four residents. The figures provide a picture of Medicaid enrollment in Huron County but do not establish how many residents will have to meet the new requirements. Enrollment may also have changed since the data were collected. Who must meet the requirements?The new rules generally apply to adults ages 19 through 64 who receive Medicaid through the expansion program and do not qualify for an exemption. Those subject to the requirements must generally complete at least 80 hours per month of approved activities. Qualifying activities include paid employment, volunteer work and certain job training programs. Individuals can combine activities to reach the required hours. Attending an approved educational program at least half-time can also satisfy the requirement. Federal regulations also allow individuals to qualify through monthly earnings equal to 80 hours of work at the federal minimum wage. That equals about $600 per month, even if the person works fewer than 80 hours. Separate Medicaid income eligibility limits still apply. Who qualifies for exemptions?Not everyone enrolled in Medicaid expansion will have to meet the work requirements. Federal regulations provide exemptions for several groups, including pregnant women, people with certain disabilities or significant medical conditions, and parents or caregivers of children younger than 14. People caring for individuals with disabilities may also qualify. Other exemptions include certain veterans with total disability ratings, former foster youth, American Indians and Alaska Natives and individuals participating in drug or alcohol treatment programs. Some recipients who meet work requirements through other public assistance programs may also be exempt. The regulations also allow states to provide temporary exceptions for certain hardships, including serious medical situations and qualifying emergencies. State begins notifying residentsThe Ohio Department of Medicaid announced Sept. 4 that it had mailed most notices to residents who might be affected by the changes. The department expected to send the remaining notices in the following weeks. The notices explain the new requirements and provide information about who may qualify for an exemption. Receiving a notice does not necessarily mean an individual will be required to complete work hours. Many Medicaid expansion recipients already meet the requirements or qualify for an exemption. For people already receiving Medicaid, compliance will be checked when their eligibility comes up for renewal after the new requirements begin. People applying for coverage will also have to demonstrate that they meet the requirements or qualify for an exemption. More frequent eligibility reviewsAnother major change involves how often Medicaid recipients must renew their coverage. Beginning in January, adults enrolled through Medicaid expansion will generally have their eligibility reviewed every six months instead of once a year. The reviews will determine whether recipients continue to meet income limits and other eligibility requirements, including the new work rules when applicable. States must first attempt to verify compliance using available information. If the state cannot confirm that someone meets the requirements, it must send a notice explaining the issue. Recipients will then have 30 calendar days to demonstrate compliance or establish that they qualify for an exemption. Those who fail to respond or cannot establish eligibility could lose their Medicaid coverage. Individuals who lose coverage because of the work requirements may reapply for Medicaid. What residents should doWith the changes approaching, Medicaid recipients are encouraged to review notices from the state and make sure their contact information is current. Residents should also determine whether they are enrolled in the Medicaid expansion program and whether they qualify for an exemption. Keeping records of employment, volunteer hours, school enrollment or other qualifying activities may help recipients demonstrate that they meet the requirements if the state requests additional information. Residents can review their benefits, report changes and renew coverage through the Ohio Benefits Self-Service Portal at benefits.ohio.gov. Those needing assistance can contact the Huron County Department of Job and Family Services at 419-668-8126. Additional information about the upcoming requirements is available through the Ohio Department of Medicaid.