Medicaid and MassHealth Changes

Due to the passage of the Big Beautiful Bill (otherwise known as OB3 or Federal Public Law 119-21), there are some changes coming to our healthcare coverages in months ahead. This is a scary time, but it’s best to stay informed.  These changes affect Medicaid at the Federal level, which means they affect MassHealth at the state level.  Let’s go through them one at a time, in the order they go into effect:

October 1, 2026 -- MassHealth Changes for Immigrants

MassHealth is the name for Medicaid in Massachusetts. Medicaid is state and Federally- funded healthcare for people with low income.

Starting October 1, 2026, the Federal government is restricting who can receive Medicaid. If you are a lawful permanent resident (LPR or Green Card), Cuban and Haitian Entrant (CHE), or a Compact of Free Association (COFA) migrant, this change will not affect you. However, if you have another immigration status, this may restrict your access to healthcare.

If you don’t qualify for coverage under MassHealth due to immigration status, you may still qualify for the following programs:

• MassHealth Standard during pregnancy & 12 months postpartum
• MassHealth Limited (emergency Medicaid)
• The Health Safety Net
• The Children’s Medical Security Program (CMSP)

To learn more about these programs, see

https://www.mass.gov/info-details/masshealth-limited-health-safety-net

January 1, 2027 -- Health Connector Changes for Immigrants

The MA Health Connector is an online marketplace where you can purchase a health, dental, or vision insurance plan. Usually, the state will pay to subsidize the cost of your healthcare through the Connector based on your income. Right now, anyone “lawfully present” in MA can qualify for the Connector.

Starting January 1, 2027, the Federal government is restricting who will receive a subsidy for the Connector. You will still be able to purchase a health insurance plan on the Connector, but it may no longer be subsidized, dependent on immigration status. If you are a lawful permanent resident (LPR or Green Card), Cuban and Haitian Entrant (CHE), or a Compact of Free Association (COFA) migrant, this change will not affect you. However, we expect this change to make health insurance harder to access for 35,000 current enrollees, including refugees.

To keep up with changes on the Health Connector, see https://www.mahealthconnector.org/updates

 

January 1, 2027 -- MassHealth Work Requirements

Starting January 1, 2027, some people who are on MassHealth will have work or community engagement requirements. If this applies to you, you will have to show proof that you are doing 80 hours per month of “qualifying activities.” This generally means hours working, volunteering, or going to school. Lots of people are exempt from this rule, meaning they can keep their MassHealth coverage without doing any more work. But a lot of people will have trouble showing proof that they are doing these things, which could lead to loss of care.

You are exempt from work requirements if:

• You are pregnant
• You are under 19 or over 64
• You just left foster care
• You are covered by the Indian Health System (IHS)
• You are a disabled veteran
• You already meet work requirements for another program, like TANF or SNAP
• You are in a drug or alcohol rehab program
• You are institutionalized
• You are the guardian or caregiver of a disabled person or child under 13
• You are “Medically frail or otherwise have special medical needs that significantly impair your ability to comply with the requirement.”

I pulled out the exact language for that last bullet point so we can unpack it. When this bill was first passed, nobody was sure how the government would define “medically frail” or “special medical needs.” The Federal government published some guidance for the states in June, so we now have a better idea how this will be implemented.

To qualify as “Medically Frail,” an individual has to meet one of the conditions in the box on the left and their condition must “significantly impair” their ability to meet the work requirements.

Even though this rule comes from the Federal government, it’s the state’s job to implement it. Different states may implement these rules differently. The states are required to use only data from the previous 12 months to make these determinations, so they have to renew the determination every year. This will cause a lot of paperwork headaches for everyone!

The Federal government is asking the states to decide who qualifies as “medically frail” following the guidelines above, but isn’t specifying exactly what kind of data they need from your doctor. That will be up to Massachusetts.

In January 2027, you will not need proof of your disability; you will be taken at your word. However, after January 2028, you will need medical verification that you are medically frail. You will want to use this time to make sure you are set up to see a primary care provider at least once a year. That way, they can set up your paperwork to verify your medical frailty for the following year.

 

To keep up with MassHealth changes, see

https://www.mass.gov/federal-changes-affecting-masshealth-medicaid-members

 

These are big changes to our medical system in Massachusetts, so expect some long wait times and paperwork snarls. Remember that these changes were made at the Federal level, not by any of the people working at MassHealth or the Health Connector.

If you want to learn more about immigrant’s rights in MA, check out The Center for New Americans in Western MA at https://cnam.org/ or the Massachusetts Immigrant and Refugee Advocacy Coalition at https://miracoalition.org/.

Rachael Cowan
Systems Change Advocate, Stavros CIL