Thanks to Lauren Howard from our team for writing this blog. Lauren has been an absolutely stellar member of our team while District Director Elena Cohen has been on parental leave. We feel very lucky to have had Lauren’s big heart and big brain on the team.
Last July, when the One Big [Brutal] Bill Act (OB3) was signed into law, it included major changes to Medicaid. These changes included new rules and eligibility requirements for MassHealth members. These new rules did not go into effect immediately — several of the largest changes are scheduled to go into effect starting in the Fall of 2026.
Nevertheless, with an estimated 360,000 current MassHealth members expected to be affected, it is never too early to start preparing. In early February, our office attended a briefing with state colleagues to learn about the effects of the OB3 on MassHealth eligibility.
The largest changes will be implemented in three waves.
- In October 2026, some immigrants will experience changes in coverage and eligibility. MassHealth estimates that these changes will affect an estimated 2,500 members who are refugees, asylees, parolees, and certain victims of abuse and trafficking.
- In January 2027, several major Medicaid eligibility changes will go into effect for certain adults between 19 and 64. Impacted members will need to renew their MassHealth eligibility every six months and meet work requirements to retain coverage. Retroactive coverage will also be reduced to 1 month for adults who qualify under the MassHealth expansion criteria and two months for others in January 2027.
- Adults with an income about 100% of the federal poverty level (FPL) must meet cost sharing requirements starting in October 2028.
In the months ahead, the federal government will issue additional guidance to MassHealth about these new rules, including cost sharing requirements. We will keep you updated as we receive more information about cost sharing requirements and other changes.
It is important to note that these new rules will only affect certain members and that the new requirements have some exemptions.
For example, members will be exempt from work requirements if they are pregnant; a parent, guardian, or caretaker of a child under the age of 14 or a person with a disability; a participant in a substance use treatment or rehab program; or if they meet another federal exemption. To best support members navigating these changes, MassHealth will use existing data to identify members who are exempt or already meet work requirements to minimize the number of people who need to take action.
MassHealth will begin communicating directly with affected members during Summer 2026. Impacted members should expect to receive mailed notices, texts, phone calls, and emails.
MassHealth will also host public facing webinars, work with community-based organizations, and post information on its website and social media to spread the word about these changes and support members.
For questions about MassHealth eligibility, managed care enrollment, and covered services, members can contact the Customer Service Center at (800) 841-2900 and the My Ombudsman Program at www.myombudsman.org or (855) 781-9898. Members can also schedule a phone or video appointment with a MassHealth representative.
Please do not hesitate to reach out to our office if we can be of any assistance.
