MedicaidAdministrativeMedium impact
[New York] Medicaid 2027 work requirements: What care providers need to know
Anthem BCBS·NY·Government Programs
Effective date
Jan 1, 2027
We identified it
Sep 2, 2026
Summary
Effective January 1, 2027, New York Medicaid will implement work requirements for certain non-disabled adults ages 19-64 in the expansion population. Members must report an average of 80 hours per month of work, school, community service, or combinations thereof to maintain eligibility. Medicaid will verify eligibility through data sources when possible; members who cannot be verified must complete manual reporting to avoid coverage loss.
Action Required
By November 1, 2026: Billing and front office staff should prepare to support patient communication about work requirement changes. Recommend: (1) Train staff to identify affected Medicaid members (ages 19-64, expansion population, no disability/qualifying condition); (2) Create patient education materials explaining the 80-hour monthly work requirement and renewal process; (3) Advise patients to keep contact information current with NY State of Health to receive official notifications; (4) Flag charts of potentially affected members to remind providers to discuss work requirement status during visits; (5) Establish workflow to verify Medicaid eligibility status prior to billing for affected members, as coverage gaps may occur if requirements are not met. Billing impact: Claims submitted for members who have lost eligibility due to non-compliance with work requirements will be denied. No billing code changes required, but eligibility verification becomes critical before claim submission.