MASSHEALTH OFFICIALS HAVE LESS than seven months to prepare for federal upheaval, as eligibility changes and work requirements reshape how and whether low-income residents can access public insurance.
As the agency navigates how to minimize coverage losses, cope with federal funding cuts and keep MassHealth members informed, the 2026 Medicaid Summit on Tuesday brought together state government policy experts and researchers from around the country to make sense of the impacts of the nearly one-year-old federal One Big Beautiful Bill Act.
Summit speakers, including a MassHealth official, say they are sifting through nearly 400 pages of guidance that the Centers for Medicare and Medicaid Services released last week concerning new work requirements and understanding who’s exempt.
Here are some takeaways from the summit co-hosted by The Council on State Governments, CSG East and the Massachusetts Developmental Disabilities Council.
- NOW APPROACHING WORK REQUIREMENT, REDETERMINATIONS: Starting January 1, 2027, adults ages 19 to 64 must satisfy a monthly 80-hour work requirement to stay eligible for Medicaid. CMS says “qualifying activities” include employment, education, job training and volunteering. The federal law carves out exemptions for those who are pregnant or postpartum, disabled or medically frail, or are parents or caregivers to children under age 14 or individuals who are disabled. Also starting next year, states must redetermine Medicaid eligibility every six months.
- EARNINGS TWIST: Medicaid members can also meet the work requirement if they earn at least 80 times the federal minimum wage ($7.25/hour), which equates to $580 monthly, said Gelila Selassie, director of health advocacy at the national group Justice in Aging. Selassie said that provision “is really important for states like Massachusetts,” where the minimum hourly wage is $15. A Bay State worker would need to clock 39 hours, or less than 10 hours of work per week, to earn $580. “It actually helps blue states in a way I don’t think Congress intended,” Selassie told the News Service.
- LESS THAN ONE IN FIVE SUBJECT TO WORK REQUIREMENT: MassHealth, which is the state’s Medicaid and Children’s Health Insurance Program, has just under 2 million insured members. Elizabeth LaMontagne, the agency’s chief operating officer, said about 360,000 members will be subject to the work and education requirements. “But many of those will have individual-level exemptions when we’re thinking about pregnancy, having a complex condition that makes you medically frail, having a child under the age of 14, and the other exemptions we walked through,” LaMontagne said.
- PREVENTING COVERAGE LOSSES: LaMontagne outlined approaches for MassHealth to stave off coverage losses, starting with the agency automatically identifying members who are not affected by the work requirements. “We know that first step is really critical in making this 1) as easy as possible for members and 2) helping minimize administrative coverage loss as much as possible,” LaMontagne said. For remaining members, LaMontagne said the agency plans to rely on other data sources, including around income and higher education enrollment, to automatically confirm if they meet eligibility criteria. As for the MassHealth members who cannot be automatically enrolled or verified, LaMontagne stressed the importance of the state teaming up with community organizations like Health Care for All. “We’re working with health plans, providers, community groups, making sure assisters are well trained, and a whole host of folks across the state so that they either can help them directly or know exactly where to point them at MassHealth or another community group to help them complete that application, complete their renewal form, or understand what documentation they might have to upload,” she said.
- MAJOR OUTREACH EFFORT: Using lessons learned from the redetermination effort after the COVID pandemic, LaMontagne said MassHealth intends to conduct “direct outreach” to members through a mix of mailers, texts, emails and robocalls. “We’re putting together a communications toolkit in partnership with Health Care for All,” LaMontagne said. “Once it’s finalized, probably in early July, we’ll be really blasting out really broadly to really make sure folks know what’s happening and what website they can go to to learn more, creating a one-stop shop for folks who might be impacted by these changes.” The agency is also planning a webinar series for later this summer to help members navigate medical frailty paperwork, she said. Materials will be provided in the top six languages spoken by MassHeath members.
- NO CHANGES YET: “Nothing has changed yet,” LaMontagne said as she urged MassHealth members to keep going to doctor’s appointments. Members should also notify MassHealth about life changes such as a pregnancy or recent disability. LaMontagne added, “Always read or reply to letters from MassHealth. The blue envelope is the renewal, but there’s other envelopes that contain important information about your coverage as well.”
- “MOVING FAST” ON RURAL HEALTH: Massachusetts has secured $162 million from the Rural Health Transformation Program baked into the new federal law. The state plans to invest the money in innovative care delivery models, workforce development, community-based chronic disease prevention programs, EMS integration in rural communities, facility upgrades and technology improvements, among other initiatives, said Eliza Lake, director of health policy and strategic initiatives at the Executive Office of Health and Human Services. The procurement process for rural communities and organizations will begin “hopefully this month,” she said. “We need to sort of focus on the most shovel-ready or the quickest things to get the money out because under the CMS rules, we have to have all the money obligated — all $162 million — by the end of October,” Lake said. “And then the contracts have to be fully expended out by the end of September of next year. We also will have an annual report, as well as a re-application due at the end of the summer, and so we are moving fast and trying to make sure that we do this in a very responsible and organized way while meeting the deadlines that are required.” CMS says $10 billion will be made available every year nationwide from 2026 to 2030 as part of the $50 billion program. The money can’t be spent on construction, which Lake said prevents healthcare facilities from expanding their footprint or opening new sites. But she said the money can be used on renovating facilities and replacing systems like HVAC.
- HOME AND COMMUNITY-BASED SERVICES: While the vast majority of older adults and individuals with disabilities rely on unpaid family caregivers, Medicaid is the primary payer when it comes to formal home and community-based services like personal assistance, day programs, assistive technology and home modifications, said Joe Caldwell, director of Brandeis University’s Community Living Policy Center. But Caldwell said those services are optional, meaning states can choose to tighten eligibility and install caps on services and supports. That can create long wait lists for care, which in turn “often results in a lot of people going into more expensive nursing homes and institutions,” Caldwell said. He said states that make an upfront investment in home and community-based services can “bend the cost curve” over time, including by reducing preventable emergency department visits and hospitalizations.
