Medicaid expansion adults renew every 6 months from January 1, 2027

Expansion adults are patients ages 19 to 64 covered through the Affordable Care Act's Medicaid expansion. Check their coverage before every visit.

Chris Hume
Head of Growth and Operations, JotPsych

Your Medicaid patients check in with the cards you scanned at intake. You checked their coverage once. You've booked every visit since on that one check.

Under the 2025 budget law, a 6-month cycle replaces the 12-month cycle the Affordable Care Act set for expansion adults. Without a new check, you'd learn about a coverage lapse from an eligibility denial after the visit.

1. Run a coverage check before each Medicaid visit. Run it the day before, so you have time to reach your patient.
2. Ask about mail from the state at check-in. Renewal forms carry a due date, and a missed due date can end coverage. Offer a phone and a few minutes to call your state Medicaid office.
3. Call the patient when a check comes back inactive. Move the visit or see the patient as self-pay. You'll spare your patient a surprise bill.

The law also adds a work requirement. By January 1, 2027, expansion adults will need to meet the requirement in 1 or more months between renewals, per KFF. Some patients are exempt, per KFF’s summary of the law.

Under 42 CFR 435.552(a), a month counts with 80 hours of work, community service, or a work program. Half-time school counts too. So does a month with 80 hours of those activities combined, or with monthly income of at least 80 hours at the federal minimum wage. Seasonal workers can average that income over the past 6 months.

Your state can start the work requirement sooner. The Department of Health and Human Services can also give a state until December 31, 2028, if the state shows a good-faith effort, per KFF’s guide. Ask your state Medicaid office which date applies to your patients.

Lapses will cost more from January 1, 2027. Medicaid will cover an expansion adult's medical bills for only one month before a new application, down from 90 days, per KFF’s summary of the law. Your visits during a lapse can go unpaid.