The 2025 budget reconciliation law, the One Big Beautiful Bill Act (OBBBA), includes significant changes to Medicaid coverage under the Affordable Care Act (ACA) expansion, effective January 2027. Under OBBBA, Medicaid enrollees and applicants in the expansion eligibility category will be subject to new work requirements and more frequent eligibility redeterminations.
Pregnant and postpartum women are exempt from OBBBA’s work requirements and are not subject to semiannual eligibility checks because of federal continuous coverage requirements throughout pregnancy, delivery, and the postpartum period—up to 12 months after the end of pregnancy in most states.
Under this new mandate, individuals ages 19 to 64 enrolled in Adult Medicaid Expansion must meet a mandated work requirement of 80 hours per month. This includes employment, participation in work programs, community service or volunteer work, or enrollment in an education program at least half-time (or 40 hours a month). States do not require pregnant individuals to document work, education, or volunteer hours to maintain eligibility.
Although pregnant women are exempt from Medicaid work and community engagement requirements, they may nonetheless face a heightened risk of disenrollment under OBBBA if state agencies are unable to promptly identify pregnant or postpartum expansion enrollees.
It’s important not only to know the facts but also to share them with anyone who may be affected, to understand the work requirement exemption, and to know how these exemptions are verified. Currently, exemptions will extend to those who are pregnant, postpartum, children, individuals with disabilities, and people classified as medically frail. This includes individuals with recognized disabilities, such as physical, intellectual, or developmental disabilities that impair daily living tasks, including bathing, eating, dressing, and toileting, among other limitations. Other individuals who meet this classification may have a chronic or serious medical condition, a mental health disorder that interferes with daily living, or a substance use disorder.
Getting a medical frailty exemption requires those enrolled in Adult Expanded to demonstrate they have an illness, condition, or disability that prevents them from meeting the 80-hour-a-month work or community engagement requirement.
Additionally, verification of medical frailty may also be determined by health records and insurance claims. So health insurance plans and a person’s doctor can help provide documentation for a medical frailty exemption. This may require individuals covered by expanded Medicaid to submit biannual (every six months) medical documentation to maintain exemption status.
Help spread the word to pregnant and postpartum people about these new mandates that could affect their coverage.
- Work mandates. Starting January 1, 2027, individuals ages 19 to 64 enrolled in Adult Medicaid Expansion must meet a mandated work requirement of 80 hours per month. This includes employment, participation in work programs, community service or volunteer work, or enrollment in an education program at least half-time (or 40 hours a month).
- Medicaid redetermination. Those enrolled in Medicaid will now be required to update their status every six months. Those who fail to do so will lose coverage.
- Financial verification. New tools are being used to verify income. This includes bank accounts, property transfers, and trust documents to ensure enrollees meet specific income guidelines.
- Only one month of past bills will be covered. If you are enrolling in Adult Expanded Medicaid in Missouri, don’t wait. Starting January 1, 2027, only one month of past medical bills will be covered, down from three.
If you are enrolled in Medicaid, watch the mail to avoid losing your benefits. Redetermination is based on the month you enrolled in Medicaid. To avoid losing coverage, follow these steps:
Watch the mail: You will receive a prepopulated renewal packet in the mail about 55 days before your renewal or redetermination month.
Update your information: Ensure the Family Support Division (FSD) has your current address, phone number, and household details. Report any changes immediately online or by phone.
Respond quickly: Submit your forms and requested proof of income before the specified deadline to prevent your coverage from lapsing.
To confirm your specific renewal date or report changes, log in to your account via the Missouri Family Support Division Benefit Portal at https://mydss.mo.gov/renew or call the FSD information line at 855-373-4636.
Do your best to keep your Medicaid information current. Wait times and backlogs are real. Start early. Here’s how:
Online: Visit myDSS Missouri and click “Report a Change” to securely enter your details. You can also manage your information by logging into your account via the FSD Benefits Portal.
By Phone: Call the Family Support Division (FSD) at 1-855-373-4636.
In Person: Visit your local FSD Resource Center. You can find exact locations using the FSD Office Locator.
By Mail: Download and complete the https://dssmanuals.mo.gov/wp-content/uploads/2023/02/im_145.pdf form, and mail it to your local FSD office.
Contact a community health insurance professional, like Samuel U. Rodgers Health Center, for help. Also, if you know someone who is postpartum, please share this information, as these changes may be affecting them sooner rather than later. Let’s work collectively to help our communities maintain access to healthcare by providing support that prevents the loss of Medicaid benefits.
