Helping Patients Navigate New Medicaid Rules

Congress recently passed a budget reconciliation bill, H.R. 1 – One Big Beautiful Bill Act, aimed at reducing federal spending, which includes deep cuts to Medicaid, one of the largest federal and state-run programs providing health coverage to low-income individuals, children, seniors, and people with disabilities. According to the Congressional Budget Office, the law, enacted on July 4, will reduce Medicaid funding by $1 trillion and increase the uninsured rate by 11.8 million over the next decade [1]. Provisions like work requirements, provider tax changes, and stricter eligibility verification will have lasting consequences for the 72 million Americans—including 15 million Californians—who rely on Medicaid (i.e., Medi-Cal in California). For community health centers (CHCs) like Northeast Valley Health Corporation (NEVHC), these cuts threaten the healthcare safety net. As we approach Medicaid’s 60th anniversary on July 30, we reflect on the challenges ahead and our continued commitment to equitable healthcare access. 

What is in the text? 

H.R. 1 includes harmful provisions that aim to reduce costs on the Medicaid infrastructure, such as the Medicaid community engagement requirement, which requires 80 hours of work each month to maintain Medicaid eligibility. Also known as a work reporting requirement, enrollees who are within the “expansion populations, those between 19-64, will be required to report whether they participated in community service, formal employment, or enrolled in an educational program, at least part-time, or a combination of these.  Individuals are exempted from this requirement if they are parents with children under 14 years of age, pregnant/postpartum, disabled veterans, medically frail, seniors, and more [2]. 

Impact of Work Requirements? 

Work requirements, though not set to begin until December 31, 2026, are projected to cause significant harm—an estimated 1.4 million Californians could lose Medi-Cal coverage in the first year alone, according to the Urban Institute [3]. One major concern is the administrative burden of monthly verification, which has already had devastating effects in other states. In 2018, Arkansas implemented Medicaid work requirements and saw 25% of enrollees lose coverage due to confusing and burdensome reporting systems, including online portals that many found difficult to navigate [4]. At NEVHC, our Enrollment Navigators already see how challenging it is for patients to enroll or maintain coverage—these new requirements would only make it harder.  

Painting a Picture 

NEVHC assists with Medicaid (i.e., Medi-Cal) eligibility and enrollment for patients and the community. The populations we serve often face complex life circumstances that make it more difficult to meet reporting requirements—including young or single parents, students, low-income households, seniors, and individuals experiencing homelessness. 

NEVHC’s Enrollment Navigators frequently assist patients who face barriers such as: 

Digital Divide: Many lack email, internet access, or tech skills to use platforms like BenefitsCal. This website is required to enroll in Medi-Cal. 

Complicated Enrollment Process: 

• Multi-step screening includes household composition, income verification, and documentation (ID, proof of residency). 
• Income fluctuations make eligibility hard to determine and maintain. 
• Frequent miscommunication with county offices (e.g., DPSS) or long hold times. 

Communication Gaps: 

• Notices regarding a client/patient's application are sent by mail only, and are often delayed or lost. 

• Language barriers make navigating applications, websites, and health plan selection difficult.

Access Issues: 

• Patients must create email accounts, upload documents, and complete applications online—often with direct assistance from navigators. 

• Even after submission, approvals take up to a month or more, after which patients can then choose a health plan and provider, delaying actual access to care by 2–3 months. 

How to prepare now 

Although the federal Medicaid work requirements are not set to begin until January 1, 2027, individuals can begin preparing for what to expect.  

• Understand Exemptions: Patients should examine if they are exempt from reporting work hours. For example, parents with children under 14 years of age or women who are pregnant or post-partum are exempted.  

• Start Tracking Work or Community Engagement: Begin understanding what qualifies as working hours, including formal employment or community service (e.g., volunteering at a food bank). Individuals should keep logs of hours, including their pay stubs, employer letters, school enrollment, and volunteer confirmations. 

• Gather necessary documentation: Similarly to tracking hours of work, individuals should ensure they have documents that verify whether they are exempt from reporting work requirements, or income, ID, and residency. 

• Get Familiar with BenefitsCal and the LA County Department of Public Social Services (DPSS) Systems: Many updates will be available through the BenefitsCal or your local DPSS office. Navigating these systems is key to maintaining coverage. For those not familiar with navigating the website, they offer How-To Videos.  

 Community health centers, including NEVHC, will always be there for their patients to help them during this especially difficult time. Our Community Resource Counselors can assist over the phone or in person at NEVHC’s Community Resource Center with Medi-Cal (i.e., Medicaid) enrollment. 

Have more questions? Don’t hesitate to reach out and visit NEVHC’s Community Resource Center at (866) 696-3842 or email resourcecenter@nevhc.org 

Written by Julie Leyba, Government & Community Relations Manager

References

[1] Hinton, E., Diana, A., & Rudowitz, R. (2025, June 20). A closer look at the Medicaid work requirement provisions in the “Big Beautiful Bill." Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/issue-brief/a-closer-look-at-the-medicaid-work-requirement-provisions-in-the-big-beautiful-bill/

[2] Hinton, E., Diana, A., & Rudowitz, R. (2025, June 20). A closer look at the Medicaid work requirement provisions in the “Big Beautiful Bill." Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/issue-brief/a-closer-look-at-the-medicaid-work-requirement-provisions-in-the-big-beautiful-bill/

[3] Miarkin, C. (2025, July 29). How Trump’s budget will change health care in California. CalMatters. Retrieved from https://calmatters.org/health/2025/07/federal-budget-health-care-medicaid-medi-cal/

[4] Rudowitz, R., Tolbert, J., Cervantes, S., & Burns, A. (2025, February 18). 5 key facts about Medicaid work requirements. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-work-requirements/ bigrapidsnews.com+15