MedicaidCoverageHigh impact
H.R. 1 Federal Work Requirement, Six-Month Renewals, and Medicaid Eligibility Changes for Non-Citizen, Non-Pregnant Adults
Virginia Medicaid - DMAS·VA·Enrollment
Effective date
Oct 1, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid is implementing three major eligibility and enrollment changes under H.R. 1: (1) restricting full-benefit Medicaid for non-citizen, non-pregnant adults effective October 1, 2026; (2) imposing federal work requirements (80 hours/month work, school enrollment, or $580+ monthly income) for Medicaid Expansion adults ages 19-64 effective January 1, 2027; and (3) reducing Medicaid Expansion eligibility review cycles from 12 months to 6 months effective January 1, 2027. Additionally, retroactive coverage is reduced to 1 month for Medicaid Expansion and 2 months for other groups. Billing teams must verify eligibility before each service and update workflows to account for more frequent renewals and work requirement documentation.
Action Required
REQUIREMENTS:
By September 24, 2026 (Healthcare Provider Town Hall): Billing, scheduling, and patient access staff must attend the Virginia Medicaid H.R. 1 Town Hall (7:30 a.m.–8:30 a.m.) to understand implementation requirements. Register at Virginia Medicaid H.R. 1 Town Halls webpage.
By October 1, 2026: (1) Billing team must update eligibility verification procedures to screen for immigration status for non-pregnant adult patients. Patients who are not U.S. citizens, U.S. nationals, Lawful Permanent Residents, Cuban-Haitian Entrants, or COFA migrants must be reviewed for Emergency Services Medicaid only eligibility. (2) Front desk and scheduling staff must update patient intake forms to capture immigration status. (3) Verify all member eligibility through Virginia Medicaid Web Portal (vamedicaid.dmas.virginia.gov) before rendering non-emergency services and before billing.
By January 1, 2027: (1) Billing team must update system workflows to recognize 6-month renewal cycles for Medicaid Expansion members instead of 12-month cycles. (2) Implement patient outreach protocols to remind Medicaid Expansion members to respond to renewal notices within 60-90 days of issuance, as failure to respond will result in coverage termination. (3) Update prior authorization and claims submission systems to verify work requirement compliance status for Medicaid Expansion members. (4) Clinical and scheduling staff must document work requirement exemptions/exclusions (pregnancy, disability, veteran status, foster care, tribal membership, Medicare enrollment, medical frailty, temporary hardship, high unemployment area, etc.) in patient records before billing to support eligibility claims. (5) Billing team must verify retroactive coverage dates—reduced to 1 month for Medicaid Expansion (vs. prior standard)—before billing claims retroactively. (6) Provider enrollment information in PRSS (Provider Services Solution) must be current; MCOs and DMAS will not pay claims to network providers with outdated enrollment. Update at vamedicaid.dmas.virginia.gov/prss or contact Gainwell for revalidation.
ONGOING: Encourage all patients to maintain current contact information (mailing address, phone, email) with Virginia Medicaid to receive eligibility notices. Failure to respond to renewal notices or provide required documentation will result in loss of coverage and claim denials. Providers must verify eligibility before EVERY visit and billing encounter. Contact Virginia Medicaid Provider Helpline (1-804-786-6273 or 1-800-552-8627, Monday–Friday 8 a.m.–5 p.m.) or Cover Virginia Call Center (1-855-242-8282) for member and eligibility questions.