People covered by Medicaid, the joint federal-state health insurance program for low-income individuals, face new enrollment rules that take effect in 2027. The One Big Beautiful Bill Act of 2025 introduced those changes on what the law itself describes as a short implementation timetable. States must begin notifying affected enrollees in September.
What the new rules require of enrollees
The 2025 law adds two new conditions to Medicaid eligibility. The first is twice-yearly eligibility checks: a mechanism requiring enrolled beneficiaries to verify their continued eligibility at two separate points during the year. The second is work requirements, a policy that makes continued health coverage conditional on employment or related work activity.
Researchers expect both provisions to reduce overall Medicaid enrollment. The concern they raise: some people who lose coverage will still qualify for the program. They will fall off the rolls because they could not understand what was being required of them, or because they never received adequate notice.
What states are required to do
Federal law sets a floor: each state must reach affected enrollees through at least two distinct outreach methods. What those methods are is left entirely to state discretion.
States that design stronger outreach campaigns are likely to reach more beneficiaries before 2027. States that stop at the two-method minimum may leave many enrollees without a clear picture of what is now expected of them. Researchers studying outreach design describe the potential for confusion and chaos as real, with the highest risk falling on beneficiaries who are uncertain whether the new requirements apply to their specific situation.
What the research is trying to answer
The analysis described in this piece is aimed at state administrators now facing the September deadline. Researchers frame their findings as practical guidance: which outreach approaches are most likely to reach the populations these changes will affect most. The notification window opens months before the 2027 implementation date, leaving time to act on what the research recommends.
The readout that will matter most is not how many notices get sent. It is how many people who still qualify for Medicaid actually keep it.