Medicaid redetermination in 2026 is entering a new phase that could affect millions of Americans. Under the One Big Beautiful Bill Act signed into law, states must now conduct eligibility redeterminations every six months (instead of every 12 months) for Medicaid expansion populations starting December 31, 2026. Combined with new work requirements and stricter verification rules, an estimated 7 to 10 million additional people could lose Medicaid coverage over the coming years. If you are currently enrolled in Medicaid, understanding these changes and acting quickly is critical to maintaining your health coverage.
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What Is Medicaid Redetermination?
Medicaid redetermination is the process by which your state reviews your eligibility for Medicaid coverage. During a redetermination (also called a renewal), the state checks whether your income, household size, and other circumstances still meet the program's requirements. If you no longer qualify, or if you fail to respond to renewal paperwork, your coverage can be terminated.
Prior to 2023, states had paused redeterminations during the COVID-19 public health emergency. When the "unwinding" began in April 2023, over 25 million people were disenrolled from Medicaid nationwide, according to data from KFF. Many of those disenrollments were procedural, meaning people lost coverage not because they were ineligible but because they did not complete renewal paperwork in time.
What Changed in 2026 Under the One Big Beautiful Bill Act?
The One Big Beautiful Bill Act (H.R. 1), signed into law in 2025, made several major changes to Medicaid that take effect in 2026:
| Change | Details | Effective Date |
|---|---|---|
| Six-month redeterminations | States must redetermine eligibility every 6 months for expansion adults (ages 19 to 64 without disabilities) | December 31, 2026 |
| Work requirements | Enrollees must complete 80 hours per month of qualifying activities | December 31, 2026 |
| Stricter identity verification | New documentation requirements at application and renewal | Varies by state |
| Delayed streamlining rules | Previously finalized rules to simplify enrollment were postponed | Immediate |
Who Is Affected by the Six-Month Redetermination Requirement?
The six-month redetermination requirement applies specifically to Medicaid expansion populations. This includes low-income adults ages 19 through 64 who do not have disabilities and who gained coverage through their state's Medicaid expansion under the Affordable Care Act. Currently, 40 states plus Washington, D.C. have expanded Medicaid.
Groups exempt from six-month redeterminations include:
- American Indian and Alaska Native individuals
- Individuals in U.S. territories
- Traditional Medicaid populations (elderly, disabled, children, pregnant women)
What Are the New Medicaid Work Requirements?
Starting December 31, 2026, most expansion-eligible adults between ages 19 and 64 must complete at least 80 hours per month of qualifying community engagement activities to maintain Medicaid coverage. Qualifying activities include:
- Employment (full-time or part-time)
- Job training or vocational education
- Enrollment in an educational program (at least half-time)
- Community service or volunteer work
- Job search activities
- A combination of the above
Who Is Exempt from Work Requirements?
The law includes several exemptions. You may be exempt if you are:
- Pregnant or within 60 days postpartum
- A parent or caretaker of a child age 13 or younger
- Medically frail or have a qualifying health condition
- A full-time student
- Receiving unemployment benefits
- An American Indian or Alaska Native
- Age 55 or older (in some interpretations; check your state's guidance)
2026 Medicaid Income Limits by Household Size
Medicaid eligibility is based on your Modified Adjusted Gross Income (MAGI) relative to the Federal Poverty Level (FPL). In Medicaid expansion states, the income limit is generally 138% of the FPL. Non-expansion states typically set lower thresholds that vary widely.
2026 Federal Poverty Level and Medicaid Income Limits (48 Contiguous States)
| Household Size | 100% FPL (Annual) | 138% FPL (Annual) | 138% FPL (Monthly) |
|---|---|---|---|
| 1 | $15,960 | $22,025 | $1,835 |
| 2 | $21,640 | $29,863 | $2,489 |
| 3 | $27,320 | $37,702 | $3,142 |
| 4 | $33,000 | $45,540 | $3,795 |
| 5 | $38,680 | $53,378 | $4,448 |
| 6 | $44,360 | $61,217 | $5,101 |
| 7 | $50,040 | $69,055 | $5,755 |
| 8 | $55,720 | $76,894 | $6,408 |
Source: 2026 HHS Poverty Guidelines (effective January 14, 2026). In non-expansion states, income limits may be significantly lower. Check with your state Medicaid office for exact thresholds.
Key Medicaid Redetermination Deadlines in 2026
| Deadline | What Happens |
|---|---|
| January 5, 2026 | CMS required to issue guidance on new redetermination rules |
| Throughout 2026 | States conduct annual redeterminations on rolling basis |
| December 31, 2026 | States must implement six-month redeterminations for expansion populations |
| December 31, 2026 | Work requirements must be in effect |
| Ongoing | States must achieve compliance with renewal timeliness requirements |
How to Complete Your Medicaid Redetermination: Step by Step
Follow these steps to make sure you do not lose your Medicaid coverage:
Step 1: Update your contact information. Log in to your state Medicaid portal or call your local office. Make sure your mailing address, phone number, and email are current. Many people lose coverage simply because renewal notices go to an old address.
Step 2: Watch for your renewal notice. Your state will send a renewal packet by mail, and many states also send notices electronically. Respond as soon as you receive it.
Step 3: Gather required documents. You will typically need proof of income (pay stubs, tax returns, or a letter from your employer), proof of identity, proof of residency, and Social Security numbers for household members.
Step 4: Complete and return your renewal form. You can usually respond online, by mail, by phone, or in person. Submit before the deadline listed on your notice.
Step 5: Document work requirement compliance. If you are subject to the new work requirements, keep records showing you completed at least 80 hours per month of qualifying activities. Report these hours to your state as required.
Step 6: Check your renewal status. After submitting, follow up to confirm your coverage has been renewed. Do not assume everything is fine until you receive confirmation.
Step 7: Appeal if denied. If your coverage is terminated, you have the right to appeal. Most states allow 90 days to request a fair hearing. If coverage was lost within the last 90 days due to a procedural error, you may be able to request reinstatement.
What to Do If You Lose Medicaid Coverage
If you lose Medicaid coverage during redetermination, you have several options:
- Reapply for Medicaid. If your circumstances have changed or there was an error, you can submit a new application at any time.
- Enroll in a Marketplace plan. Losing Medicaid triggers a Special Enrollment Period, giving you 60 days to enroll in an ACA Marketplace health insurance plan. You may qualify for subsidies that significantly reduce your premium.
- Check for other programs. You may be eligible for CHIP (for children), Medicare (if age 65 or older or disabled), or other assistance programs. Use our free benefits screener to find out what you qualify for.
How Many People Have Lost Medicaid Coverage?
The scale of Medicaid coverage losses has been significant:
| Metric | Figure |
|---|---|
| Total disenrolled during unwinding (2023 to 2024) | Over 25 million |
| Total renewals completed successfully | Over 56 million |
| Procedural disenrollments (estimated share) | Approximately 69% of all disenrollments |
| Net Medicaid enrollment as of late 2024 | Approximately 79 million |
| Pre-pandemic enrollment (February 2020) | Approximately 69 million |
Source: KFF Medicaid Enrollment and Unwinding Tracker; U.S. GAO.
The new six-month redetermination and work requirements are projected to cause additional coverage losses beyond these numbers, with some estimates suggesting millions more could lose coverage.
Frequently Asked Questions About Medicaid Redetermination 2026
How often will I need to renew my Medicaid in 2026?
If you are in the Medicaid expansion population (an adult ages 19 to 64 without disabilities), your state will be required to redetermine your eligibility every six months starting December 31, 2026. Traditional Medicaid populations (children, pregnant women, elderly, and disabled individuals) will continue with annual redeterminations.
What happens if I miss my Medicaid renewal deadline?
If you do not respond to your renewal notice by the deadline, your Medicaid coverage will be terminated. However, you can reapply at any time, and in many states you can request reinstatement within 90 days if the disenrollment was procedural.
Do I have to work to keep my Medicaid?
Starting December 31, 2026, most Medicaid expansion enrollees ages 19 to 64 must complete 80 hours per month of qualifying activities, which include employment, job training, education, community service, or job search. Several groups are exempt, including parents of children age 13 or younger, pregnant individuals, and those who are medically frail.
Will Medicaid expansion be eliminated?
The One Big Beautiful Bill Act does not eliminate Medicaid expansion, but it reduces the federal matching rate for expansion populations over time and adds new requirements (work requirements, six-month redeterminations) that are expected to reduce enrollment.
How do I check if my state has expanded Medicaid?
As of 2026, 40 states plus Washington, D.C. have expanded Medicaid. The 10 states that have not expanded are primarily in the South. Use our free screener to check your eligibility based on your state and income.
Can I get help with my Medicaid renewal?
Yes. Many states offer assistance through local Medicaid offices, community health centers, legal aid organizations, and navigator programs. You can also call your state's Medicaid hotline for help completing your renewal.
Protect Your Coverage Today
With the significant changes to Medicaid redetermination in 2026, staying proactive is the best way to protect your health coverage. Update your contact information, respond to renewal notices promptly, and keep documentation of your income and work activities.
If you are unsure about your eligibility for Medicaid or other benefit programs, take our free eligibility screening to get personalized results in minutes. We check eligibility for Medicaid, ACA Marketplace plans, SNAP, and many other programs all at once.
