Medicaid Renewal: How to Renew Your Coverage Without Losing It

The annual process the states use to verify Medicaid beneficiaries continue to meet the qualifications for Medicaid is called Medicaid renewal, or redetermication or recertification. All Medicaid enrollees are required to renew their coverage every year, and important changes in 2026 will dramatically make it easier to renew coverage for Medicaid expansion adults. The One Big Beautiful Bill Act (H.R. 1) enacted in 2025 requires that Medicaid expansion populations (age 19-64 without disability) renew every six months, beginning on December 31, 2026. A new set of work requirements for 80 hours per month, which will also go into effect on the same day, could take away Medicaid eligibility for an estimated 7-10 million more people over the next several years. Annual redeterminations will be continued for traditional Medicaid populations (children, pregnant women, elderly, and disabled). Beginning in April 2023, the COVID era "unwinding" began, during which roughly 25 million individuals were disenrolled from Medicaid, many of whom were disenrolled for procedural rather than actual reasons. States range widely in the level of automation of the federal ex parte renewal process, from 99% in North Carolina to as low as 3% in Wyoming. All states with compliance requirements for renewal have until December 31, 2026.

This guide outlines Medicaid renewal for 2026, the new six-month expansion adult requirement, work requirements, and how to stay on Medicaid. Medicare and Medicaid data and information are from Medicaid.gov, CMS, KFF, and guidance provided by the One Big Beautiful Bill.

The 2026 Medicaid renewal changes

A major change to Medicaid renewal is slated to go into effect at the end of this year (December 31, 2026). In 2025, the One Big Beautiful Bill Act (H.R. 1) was enacted, mandating states to re-determine eligibility for Medicaid populations that are above the federal poverty level every six months. Previously, most Medicaid enrollees had annual redemptrations.

The expansion populations impacted by the 6-month rule are adults between the ages of 19-64 who were covered by the Medicaid expansion in their state under the Affordable Care Act. As of late 2025, about 20 million people will be covered through Medicaid expansion, or about one-quarter of all Medicaid/CHIP enrollees.

People in traditional Medicaid (children, pregnant women, elderly and disabled people) and those in U.S. territories are exempt from 6-month redeterminations as are other groups. These groups have annual re-enrollments.

In addition to the new six-month reenlistment, the law requires that most adults who are eligible for a red for an expansion be engaged in 80 hours per month of community activities. Activities are classified as qualifying activities if they are a type of employment (paid work), a course of education or training (specific programs), a course of volunteer service (with an approved organization), or a course of other approved activities. The work requirements will be implemented on December 31st, 2026.

Disability, pregnancy, some custody arrangements for children under 6, primary caregiver of an ill family member, students and certain other conditions are exemptions to the work requirements.

See our Medicaid qualification for details of Medicaid qualification. 

How the renewal process works

The federal Medicaid renewal process is by "ex parte" (automatic) renewal where possible, and by traditional application when it does not occur.

Ex parte renewal: As the renewal date nears, the state agency reviews the available electronic data sources to see if you are still eligible for the renewal. The sources of data are the State Wage Information Collection Agency (SWICA), the Social Security Administration, state unemployment compensation data, data from human services agencies (in limited circumstances), and IRS data. If the data verifies that the person is still eligible, they are automatically covered, and no steps are required. A notice of approved eligibility is sent to you.

Ex parte renewal failure: If the state is unable to establish eligibility based on data it has (it does not fail the renewal), the state mails a renewal form. It can be completed and returned to you within 30-45 days. If they don't show up, they are disenrolled.

The percentage of ex-ante renewals differs significantly from state to state. Nearly all Medicaid enrollees are automatically renewed without any paperwork (99% ex parte renewal). Only Wyoming has a 3% ex parte renewal rate, meaning that the majority of enrollees need to do some paperwork to renew. The majority of states are in the middle. The variation from state to state is caused by technology, data integration and state policies.

Coverage continues during the renewal period as long as you respond timely. No response by the deadline means coverage will usually expire 30-60 days after the missed deadline.

For working past 65 with Medicare for those transitioning from Medicaid, see our working past 65 guide.

The unwinding context

It is important to understand the context of the “unwinding” that happened during the COVID era, to understand the changes which will occur in 2026 when renewals are made. States must keep people on Medicaid continuously throughout the COVID-19 Public Health Emergency, under the Families First Coronavirus Response Act of 2020. During this time period, March 2020 to March 2023, states were prohibited from removing Medicaid beneficiaries from the program even if they were no longer eligible.

This continuous enrollment provision added up to a record 94 million patients enrolled in Medicaid by April 2023. The unwinding started on April 1, 2023, when states began to disenroll ineligible members or individuals who have not responded to renewal notices.

Through August 2024, there were 25 million fewer people enrolled in Medicaid. About half of the disenrollments were "procedural" (or lost due to failure to respond to renewal notices or paperwork) rather than because people were no longer eligible. This issue was particularly impacting on communities of color, communities with limited English proficiency, and low-income families.

As the incident was resolved, it exposed serious issues with renewing Medicaid in New Mexico. CMS identified compliance problems with renewal requirements in about half of states. States created different flexibilities (known as "e14 waivers") to simplify renewals. Many states even found their renewal systems were not up to the task of effectively processing the increased volume.

CMS created a compliance roadmap, setting December 31, 2026 deadlines for all states to comply. States who have been identified as having deficiencies must submit improvement plans with 6-monthly check in. 

Strategies to maintain Medicaid coverage

Several practical strategies help maintain Medicaid coverage through renewals.

Update your contact information whenever it changes. Make sure your state Medicaid office has your current address, phone number, and email. About 30% of disenrollments during the unwinding came from returned mail (state couldn't reach enrollees).

Respond promptly to all renewal notices and requests. States typically allow 30-45 days to respond. Earlier response gives the state time to process your renewal before your coverage ends.

Keep documentation organized. When a renewal request requires documentation, you may need pay stubs, tax returns, asset statements, residency proof, or other documents. Having these organized and accessible speeds responses.

Set calendar reminders for your renewal date. Most states renew on your enrollment anniversary. Mark this date and the 90 days preceding it to ensure you're paying attention to renewal notices.

Verify your eligibility before renewal. If your income or family size has changed, you may now qualify for higher Medicaid benefit levels or different programs. Calculate your current eligibility against current state thresholds.

If your state has a 1902(e)(14) waiver, you may benefit from expanded ex parte renewal. Check your state's specific renewal procedures.

If you're disenrolled procedurally (for failing to respond), most states allow reinstatement within 90 days if you can demonstrate you remained eligible. Apply for reinstatement quickly.

For Medicaid spend-down planning, see our spend-down guide.

What happens after work requirements take effect

Starting December 31, 2026, most Medicaid expansion adults ages 19-64 must complete at least 80 hours per month of qualifying community engagement activities to maintain coverage.

Qualifying activities include:

• Employment (paid work) at 20+ hours weekly

• Education or training in approved programs

• Volunteer service with approved organizations

• Job search activities

• Caregiving for children under 6 or ill family members

• Other state-approved activities

Reporting requirements vary by state. Some states require monthly reporting; others may verify through employment records. Documentation typically required includes pay stubs (for employment), training program records, or volunteer service verification.

Exemptions are available for those with disabilities, those who are pregnant, students, primary caregivers for children under 6, primary caregivers for ill family members, and other specified categories. Document your exemption to your state Medicaid office.

The work requirements particularly affect young adults, those without disabilities, and individuals in tight job markets. KFF and other research organizations estimate the requirements could cause significant additional disenrollments beyond the 7-10 million projection.

For specific work requirement details, contact your state Medicaid office or visit your state's Medicaid agency website.