MedicaidAdministrativeMedium impact
[Virginia] Medicaid 2027 work requirements: What care providers need to know
Anthem BCBS·VA·Government Programs
Effective date
Jan 1, 2027
We identified it
Sep 2, 2026
Summary
Starting January 1, 2027, Virginia Medicaid (Anthem HealthKeepers Plus) will implement federal work requirements for certain non-disabled adults ages 19-64 in the Medicaid Expansion population. Members must report 80 hours per month of work, school, community service, or combination thereof to maintain eligibility. Many exemptions apply (pregnant women, caregivers, veterans, etc.). Billing teams should prepare for potential eligibility changes and member disenrollments among affected populations.
Action Required
By December 31, 2026: (1) Billing team must review Medicaid member roster to identify Anthem HealthKeepers Plus Medicaid Expansion members ages 19-64 without documented disabilities or qualifying conditions, as these are most likely to be affected by work requirements. (2) Update billing system alerts/flags to monitor for potential eligibility terminations or coverage lapses effective January 1, 2027 for this population. (3) Clinical and front-desk staff should be trained to inform affected members to verify their eligibility status and provide contact information updates. (4) Implement process to handle claims for members whose eligibility status changes due to non-compliance with work requirements—expect potential claim denials for services rendered after January 1, 2027 if member loses coverage. (5) Direct patients to www.commonhelp.virginia.gov or Cover VA (855-242-8282) for enrollment questions. Failure to identify eligibility changes may result in claim denials and bad debt write-offs.