Department of Workforce Services 1-866-435-7414

Medicaid Health Program Representative 1-866-659-6176

Utah Medicaid
rules are changing

Read on to learn what these changes
mean for you.

On July 4, 2025, H.R. 1, also known as the One Big Beautiful Bill Act (OBBBA), was signed into law. H.R. 1 changes how some Medicaid members qualify for and keep their Medicaid coverage. Most of these changes affect adults covered through Medicaid Expansion. Some immigrant groups that were previously eligible for Medicaid may no longer qualify.

Many of these changes will begin taking effect in late 2026 and will be phased in over several years.

Read on to know more about H.R. 1 and how it may affect your Medicaid coverage!

Healthcare professional assisting a Medicaid patient

What do I need
to know?

Benefits will stay the same for the large majority of kids, adults with disabilities, elderly adults, and pregnant and postpartum women.
Some people will lose coverage if they do not meet the new requirements for eligibility, citizenship, or community engagement.
Starting January 1, 2027, some adults will need to complete an eligibility review every 6 months.
Starting January 1, 2027, some adults may also need to meet a community engagement requirement.
If you think you may be eligible for Medicaid or CHIP, you may apply at any time – even if you have lost coverage before.

Take steps to
prepare now

You can lose your Medicaid benefits if you don't return forms or miss deadlines. To make sure your information is up to date or to update your information, call:

A Medicaid health program representative at 1-866-659-6176

Your health plan

The Department of Workforce Services at 1-866-435-7414

Stay informed.

Check your mail, email, and text messages for official Medicaid program updates so you don't miss important information or deadlines.

Who may be affected?

You may be
affected if:

You are enrolled in Adult Expansion Medicaid.
You are enrolled in Targeted Adult Medicaid (TAM).
You no longer meet new eligibility, citizenship, or community engagement requirements.

You may not be
affected if:

You are a child receiving Medicaid.
You are pregnant or receiving postpartum Medicaid.
You receive Medicaid due to a disability.
You are enrolled in another Medicaid program that is not Adult Expansion Medicaid or Targeted Adult Medicaid.

About H.R. 1

Utah Medicaid is studying the new law and building tools to help affected Utahns.

To support our members, we are adding data sources to quickly and automatically check eligibility, along with increasing our outreach to help members succeed.

If you think you may be eligible for Medicaid or the Children's Health Insurance Program (CHIP), you may apply at any time. Even if you have lost coverage in the past, you can reapply. If you have questions about applying for these programs, you can call 1-877-543-7669.

Healthcare professionals reviewing patient information

Changes to eligibility reviews

Starting January 1, 2027, a new federal law called H.R. 1 (OBBBA) says that some Medicaid members must complete a renewal or review every 6 months.

What is changing?

Before this law, most members only had to renew their Medicaid eligibility once a year.

Now, some adults will have their eligibility recertification two times a year to keep their health coverage.

Who does this affect?

This change only affects adults in these two programs:

Adult Expansion Medicaid
Targeted Adult Medicaid (TAM)

If you are in any other Medicaid program, your renewal schedule will stay the same.

Who is exempt?

American Indians and Alaska Natives do not have to follow this new rule. If you are an American Indian or Alaska Native, you will still only complete a review once every 12 months.

Learn more below about your Federal Indian or AI/AN status.

Community engagement
requirement

The new federal law changed the rules for how some Medicaid members qualify for and keep their Medicaid coverage. This new rule says that certain members must now show they are working or active in their community.

Starting January 1, 2027, if this rule applies to you, you must show that you are doing one or a combination of these things for 80 hours each month in order to keep your Medicaid:

Working a job

Training for a job

Going to school (at least half-time)

Volunteering (community service)

Earning at least $580 a month

Showing why you cannot work or volunteer

You may need to provide proof of these activities every 6 months during your review.

Who is affected? +

Who is excluded from this requirement? +

What if I am not an excluded individual? +

Are there exceptions that meet the community engagement requirement? +

Who is affected?

−

This new rule applies to adults in the Adult Expansion and Targeted Adult Medicaid (TAM) programs. This includes members aged 19-64, unless they meet specific exclusion criteria.

Who is excluded from this requirement?

−

Adults who are:

Pregnant or receiving postpartum Medicaid

In foster care (or were in the past)

American Indian or Alaska Native

A parent, guardian, or caregiver for a child age 13 or younger, or for a person with a disability

A veteran with a 100% disability

Medically frail or have special needs

Subject to work requirements on the SNAP or TANF programs

Currently incarcerated

Participating in a drug or alcohol treatment and rehabilitation program

What if I am not an excluded individual?

−

If you do not meet an exclusion, you must fulfill the community engagement requirement in at least one month since your last approval or renewal.

The state will check your eligibility during the lookback months.

New members:

We look at your activities the month before you applied.

Current members:

We look at your activities from your last renewal or approval until now.

Are there exceptions that meet the community engagement requirement?

−

Since your last review or approval, you may have already met the community engagement requirement if you:

Were under 19 years old

Are enrolled in Medicare Part A or B

Received Title IV-E Foster Care/Guardianship

Received Supplemental Security Income (SSI)

Have been incarcerated at any time during the 3 months before your last approval or renewal

Received coverage under a different Medicaid program

Experienced one of the listed hardships

Changes for immigrants

H.R. 1 (OBBBA), changes who gets considered as a "qualified immigrant" for Medicaid.

Under the new law, some groups that were previously eligible for Medicaid may no longer qualify. This includes refugees and asylees, humanitarian parolees, and survivors of trafficking or domestic violence.

Starting October 1, 2026, Medicaid eligibility will generally be limited to:

U.S. citizens and U.S. nationals
Green card holders (Lawful Permanent Residents) who have lived in the U.S. for at least 5 years
People from Cuba or Haiti who entered the U.S. under special rules
COFA migrants (citizens of the Marshall Islands, Micronesia, or Palau)

Note: Children and pregnant people may still qualify for health insurance even if the rules have changed for other groups.

If your Medicaid coverage is affected, you will receive a personalized letter by October 1, 2026. The letter will explain the changes and provide information on how to appeal if you disagree with the decision.

If you are concerned about losing your Medicaid coverage, consider scheduling a doctor's appointment soon. You may also want to refill any prescription medications before October 2026. Doing so can help ensure you receive the care and medicine you need while your coverage is still active.

Information for American Indians and Alaska Natives (AI/AN)

Starting January 1, 2027, H.R. 1 (OBBBA) requires certain adults to work or participate in community activities for at least 80 hours each month to keep their Medicaid coverage. Some adults will also need to complete an eligibility review (renewal) every 6 months instead of every 12 months.

However, if you are an American Indian or Alaska Native (AI/AN) with verified Federal Indian or AI/AN status, you are exempt from these new requirements. You do not have to meet the monthly work or community activity requirement, and you will continue to complete your eligibility review every 12 months.

If your AI/AN status has not been verified, you may be required to meet the monthly work requirement to keep your Medicaid coverage.

How to get your exemption +

Where to send your verification +

How to get your exemption

−

To make sure you are exempt from these new requirements, you must submit proof of your Federal Indian or AI/AN status to the Department of Workforce Services (DWS). Send a copy of one of the following documents for each person in your household who is a Federal Indian or AI/AN member:

Federal Indian or AI/AN ID card:
Your Federal Indian or AI/AN identification or enrollment card, or your Federal Indian or AI/AN enrollment number.

CDIB document:
A Certificate of Degree of Indian Blood (CDIB) signed by the Bureau of Indian Affairs (BIA).

IHS Face Sheet:
A medical record certified by the Indian Health Service (IHS) as being from its original records. It must include your name and date of birth.

Federal Indian or AI/AN court document:
A Federal Indian or AI/AN court document that includes identifying information, such as your name and date of birth.

Descendant documentation:
Any of the documents above showing Federal Indian or AI/AN membership through a parent or grandparent. You must also provide a birth certificate or court document showing your relationship to that person.

Where to send your verification

−

Write your name and case number on every page you submit. You can send your documents by mail or fax:

MAIL:
Department of Workforce Services
Imaging Operations

P.O. Box 143245
Salt Lake City, UT 84114-3245

FAX:

Toll-Free:

1-877-313-4717

Local:

801-526-9500

To be exempt from these new requirements, you must submit your Federal Indian or AI/AN status verification by January 1, 2027.

What do I need
to do now?

You do not need to do anything right now. Most of these changes do not start until January 1, 2027 or later.

We will send you more information and a renewal letter when it is time for you to take action.

Please make sure your information is up to date.

Meanwhile, you can bookmark and keep a check on this website to know more and stay updated on the next steps.

Important dates

July 4, 2025

H.R. 1 signed into law.

October 1, 2026

Changes for who is considered a ‘qualified immigrant’ for Medicaid.

Late 2026

Implementation of many H.R. 1 provisions begins.

January 1, 2027

Community engagement requirements and 6-month eligibility reviews begin for applicable members.

June 2028

Utah's State CHIP program continues to be an option for qualifying children through June 2028.

Eligibility options and decisions

Next steps

Keep your contact information up to date.

Review the information that applies to your situation.

Read all letters, emails, and text messages from Utah Medicaid.

Contact Utah Medicaid if you have questions.

Return forms and respond before deadlines.

Apply for Medicaid or CHIP at any time if you think you may qualify.

Need help?

Eligibility Questions

Department of Workforce Services

1-866-435-7414

General Medicaid Questions

Medicaid Health Program Representative

1-866-659-6176

H.R. 1 Policy-Specific Questions

Email us at:

dih_obbba@utah.gov

Utah Medicaid rules are changing

Read on to learn what these changes mean for you.

What do I need to know?

Take steps to prepare now