Prepare for Utah Medicaid Changes in 2027
Some people insured through Medicaid will face new eligibility requirements in 2027 as part of a wide-sweeping federal law enacted in 2025, referred to as H.R. 1 or the “One Big Beautiful Bill Act (OBBBA)”. Those changes include new work requirements and more frequent eligibility redetermination. Exclusions and other changes vary by program, so make sure you know your coverage status so you can advocate for yourself if needed.
WORK REQUIREMENTS
Some Medicaid beneficiaries enrolled in Adult Expansion Medicaid or Targeted Adult Medicaid will generally have to show they spend 80 hours a month in a combination of work, job training, education, volunteer community service, or caregiving. People who are exempt from work reporting may still have to prove eligibility for exemption if Utah Medicaid does not already have sufficient information.
Despite the new requirement for reporting work, education, and caregiving hours, the income limits for Medicaid eligibility have generally not changed. People who may make above the established income limits for Medicaid remain at risk of losing their coverage.
ELIGIBILITY DETERMINATION
Under the new law, people insured through Adult Medicaid Expansion or Targeted Adult Medicaid who are not excluded or exempt from the policy will need to complete a Medicaid eligibility review or renewal every six months. Members with verified American Indian or Alaska Native status will continue to have the annual review schedule.
TIMING
The changes will take effect January 1, 2027, in Utah.
WHO THE LAW AFFECTS
The work requirements and six-month eligibility verification apply to people who became eligible for Medicaid as part of the Adult Expansion Medicaid or Targeted Adult Medicaid programs. The community-engagement requirement generally applies to members ages 19 through 64 unless they qualify for an exclusion or another exception. Contact Utah Medicaid if you are unsure which program you are enrolled in.
EXCLUSIONS
The law has many exceptions and exemptions to the new work and redetermination requirements.
1. People insured through Medicaid who meet the income threshold and additional eligibility criteria are exempt. They include children, adults with disabilities, people over 65, and pregnant or postpartum people.
2. Adults 19-64 who became eligible for Medicaid as part of a coverage expansion in their state are exempt from work requirements if they are:
- Medically frail or have complex health needs
- Parents, guardians, caregiver relatives, or family caregivers of a dependent child 13 or younger or a person of any age with a disability
- Pregnant or entitled to postpartum coverage
- Members of federally recognized tribes
- Participants in drug or alcohol rehabilitation programs
- Currently or previously in foster care
- Currently incarcerated
- Veterans with 100% disability
- Already meeting work requirements for another program such as Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program.
People eligible for at least one of these exemptions must provide documentation if their state can’t verify their exempt status through existing data systems.
3. Utah is also providing short-term hardship exemptions for people who:
- Receive inpatient or similar medical services (e.g., hospital, nursing facility, inpatient psychiatric hospital care)
- Must travel for extended periods to access medically necessary care for themselves or dependents because care isn’t available locally.
- Live in a county affected by a federally declared emergency or disaster
- Live in a county with high unemployment
Utah is adopting all hardship exceptions provided under H.R. 1/OBBBA guidelines.
HOW UTAH WILL DETERMINE COVERAGE ELIGIBILITY AND WORK REQUIREMENTS
Each time overall Medicaid eligibility is verified, Utah will use existing data to try to determine whether enrollees meet the work requirement or qualify for exemptions. If needed, Utah will reach out to enrollees for more information. If you receive a request from Utah Medicaid, you may have 30 days to send proof that you have met the work requirement or that you are exempt. Those documents include pay stubs, medical records, and doctors’ notes. People who lose their Medicaid coverage can appeal to get it back. Typically, you have 90 days to resubmit the information needed to verify eligibility and have coverage reinstated. After that time, you must start a new application for Medicaid coverage. Individuals can reapply for Medicaid at any time.
TO REDUCE THE RISK OF HAVING MEDICAID COVERAGE DISRUPTED
- Keep your address, phone number, and email up to date with Utah Medicaid.
- Check your mail regularly.
- Send documentation when asked.
- Tell Utah Medicaid if you have a life change, like income, pregnancy, ability to work, or if someone moves in or out of your home.
Click Here, for more information concerning upcoming changes in Utah Medicaid.