Changes to Medicaid eligibility are on the horizon. Beginning in 2027, some Medicaid recipients may be required to meet work or community engagement requirements. Although many people supported through the Office for People with Developmental Disabilities (OPWDD) may be exempt, taking steps now to organize important documents and staying connected with your Care Coordinator can help ensure continued coverage.
What’s Changing:
– Certain adults enrolled through Medicaid Expansion programs may be required to demonstrate at least 80 hours per month of qualifying activities, such as employment, education or training programs, volunteer, or other community engagement activities.
– Some people may also need to complete additional reporting and eligibility verification requirements to maintain Medicaid coverage.
Who is Affected:
- ACA Expansion Population/MAGI Population (those with Modified Adjusted Gross Income Medicaid)
- Ages 19-64
- Income over 100% Federal Poverty Level (FLP)
- And are enrolled in the MAGI category of Medicaid
- People who get Medicaid in other ways (e.g. Aged, Blind, Disabled) whose income is above 100% of FPL, and who are not included in the Expansion Population
Who is NOT Affected:
- Age 18 and younger or age 65 and older
- Entitled to or receiving Medicare Part A and/or Part B
- Disability determination on file with Medicaid (SSI/SSDI/VA, MBI-WPD)
- Incarcerated currently or in the prior three months
- Short-term hardship exceptions
- In hospital, nursing facility, ICF, psychiatric center
- Medical care for serious/complex condition, care not offered locally
- Federally declared disaster or emergency area
- Very high unemployment area (8% or 1.5x national average)
- Medically Frail:
- Blind or disabled, substance use disorder, disabling mental disorder, physical, intellectual, or developmental disability, or serious or complex medical condition AND unable to work
- Parent, guardian, caretaker relative, or family caregiver to a disabled individual or to a child under 14
- Current and former foster care youth up to age 26
- American Indian or Alaska Native
- In certain drug or alcohol treatment programs
- Pregnant, or were pregnant in the last 12 months
- Already meeting Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) work requirements
How to Request an Exemption:
- Proof of disability
- Self-attestation of medical frailty (2027 only)
- Doctor’s note (requirements not yet known)
- Proof of school attendance
- Information that was presented to OPWDD for eligibility and for enrollment in the HCBS waiver letter will be helpful.
How Care Coordinators Can Support You:
- Ensure contact information is up-to-date
- New York State of Health account or with Local Department of Social Services
- Report address changes
- Add CCO to notice copies
- Calm fears
- The new requirements may not impact everyone
- Encourage people to start tracking hours for volunteering and work to prepare
- Review Medicaid notices with the people they support
- Help people respond in a timely manner with:
- Proof of work/school/volunteering or proof of exception
- Self-attestation (thru 1/1/28)
- Doctor’s note
- Fair hearings
If you have any questions, please contact your Care Coordinator.
How Community Engagement is Fulfilled:
Links for further information:
