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Eligibility changes for Medicaid services are being implemented nationwide following the enactment of the One Big Beautiful Bill Act. Because of new rules, a lot of recipients, mainly non-citizens, could be left out of medical services.
Governors across the United States are already adapting their Medicaid systems to comply with the changes set to take effect on January 1, 2027.
The NC Medicaid Division of Health Benefits (NCDHHS) shared important information warning people who could lose their benefits for not achieving engagement requirements.
Trump Administration rolled out major changes for Medicaid eligibility system
According to NCDHHS, about H.R.1, "New laws are changing the rules for NC Medicaid. Some people will need to follow new rules to keep their coverage. Some non-citizens will lose their coverage."
New eligibility policies may vary depending on recipients’ ages. From now on, Medicaid requires different paperwork, and people who do not have a job, do not study, and do not volunteer in some organization won’t be able to use free healthcare.
Key Medicaid Eligibility Changes Taking Effect Under H.R. 1
Work Requirements for Medicaid Beneficiaries - Effective January 1, 2027
Many adults between the ages of 19 and 64 will be required to work, attend school, volunteer, or participate in another approved activity to keep their Medicaid coverage. These requirements generally apply to beneficiaries who are not disabled, are not pregnant, do not care for a child under age 14, and do not qualify for an exemption.
More Frequent Medicaid Renewals - Effective January 1, 2027
Some Medicaid beneficiaries ages 19 through 64 will be required to renew their coverage every six months instead of once a year. Beneficiaries will receive renewal notices and may need to provide updated information to maintain eligibility.
Changes to Retroactive Medicaid Coverage - Effective January 1, 2027
Medicaid will continue to cover certain medical expenses incurred before an application is submitted, but the coverage period will be shorter. Most adults ages 19 through 64 may receive coverage for medical bills from one month before applying, while children, adults age 65 or older, and people with disabilities may receive coverage for bills from up to two months before their application date.
New Medicaid Eligibility Rules for Non-Citizens - Effective October 1, 2026
Federal eligibility rules will limit Medicaid access for many non-citizens. However, coverage will remain available to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and eligible migrants from Compact of Free Association nations. Eligibility requirements may vary depending on immigration status and other program rules.
Who Will Lose Medicaid Coverage Under the New Federal Rules?
Beginning October 1, 2026, federal law will no longer allow certain categories of non-citizens to receive Medicaid benefits. Individuals in the following groups may lose their Medicaid coverage based on their immigration status:
- Asylees granted protection in the United States.
- Refugees admitted to the United States.
- Victims of human trafficking who receive immigration protections, including certain eligible family members.
- Individuals admitted under humanitarian parole, including many Afghan and Ukrainian parolees.
- Non-citizens whose deportation has been withheld.
- Non-citizens granted conditional entry into the United States.
- Individuals with Amerasian immigrant status.
- American Indians born in Canada or outside the United States who are not U.S. citizens, including certain federally recognized tribal members.
- Battered non-citizens who received immigration protections due to abuse by a spouse, parent, or other qualifying family member.
- Non-citizen veterans and active-duty service members, including certain eligible family members.
- Holders of Iraqi or Afghan Special Immigrant Visas and certain eligible relatives.
- Hmong, Mien, and Highland Laotian immigrants, including certain eligible family members.
- Individuals with pending applications for a green card, asylum, or Temporary Protected Status (TPS).
- Other non-citizens who are lawfully present in the United States but do not fall within the categories that remain eligible for Medicaid.