New requirements for millions of Medicaid beneficiaries in the US are set to take effect on 1 January 2027. Under the healthcare reform law, HR 1, signed by Donald Trump in July 2025, recipients in 44 states will need to demonstrate they are working 80 hours per month, attending school, or volunteering.
This change is part of a broader reform that cut approximately $1tn in federal spending from the healthcare industry. The Centers for Medicare and Medicaid (CMS) reported that Medicaid spent $937bn in 2024.
Healthcare providers, researchers, and patient advocates are concerned about the potential impact, including an increase in medical debt, more delayed care, and individuals losing coverage for which they technically qualify. Dr. Andrew Racine, president of the American Academy of Pediatrics, stated that "The costs to the family – and society as a whole – cannot be overstated."
The new rules will also require beneficiaries to re-certify eligibility every six months, instead of annually. Additionally, Medicaid coverage for retroactive care will be reduced from three months to either two or one month, depending on the applicant and state.