H.R. 1 is changing federal benefits, including who qualifies, what you may need to do to keep your coverage, and where to get help.
If you receive Medicaid or SNAP (food assistance), the changes under H.R. 1 could affect your benefits, even if you have a disability or chronic illness.
H.R. 1, also known as the One Big Beautiful Bill Act, was signed into law in July 2025. Some changes to federal assistance programs, including Medicaid and SNAP, are already taking effect, while others begin January 1, 2027 or later.
There are exemptions built into the new Medicaid and SNAP work requirements for people with qualifying disabilities and medical conditions. However, you may need to provide additional information or documentation to make sure those exemptions are recognized.
We’ve broken down the biggest changes (as we understand them today), why they matter, how to find out whether they affect you, and where to get help.
Editor’s note: The understanding and interpretation of this new law is changing almost daily, like this ruling on the definition of “medically frail.” Always confirm with your state benefits agency or qualified benefits professional.
What’s changing?
Medicaid: New work requirements begin January 1, 2027
Beginning January 1, 2027, many adults ages 19–64 receiving Medicaid through expansion programs will need to meet new work or community engagement requirements to qualify for or maintain coverage. Some states may implement the requirements earlier.
Does this apply in your state?
The new Medicaid work requirements primarily affect adults enrolled through Medicaid expansion in 40 states and Washington, D.C. Some people in Georgia, Tennessee, and Wisconsin may also be subject to these requirements, even though those states have not adopted full ACA Medicaid expansion.
Kansas residents receiving KanCare are not subject to these new requirements. However, other changes to Medicaid and SNAP may still affect Kansas residents.
Find out if your state is affected here:
For those affected, the standard is generally 80 hours per month or other equivalent activity, if you do not have an exemption.
Qualifying activities can include:
Paid employment or self-employment
Volunteering or community service
Approved job training programs
Education, including qualifying college or technical training
You may also satisfy the requirement by earning at least the equivalent of 80 hours at the federal minimum wage, currently $580 per month.
The number of months that must be verified depends on whether you’re applying for coverage or renewing it, along with your state’s implementation rules.
What happens if you don’t meet the requirements?
If you’re subject to the rules and cannot demonstrate qualifying activity or an exemption, your Medicaid application could be denied or your existing coverage could end after the required notice and response process.
What if you have a disability or chronic illness?
People with qualifying disabilities, serious medical conditions, and other circumstances may be exempt.
Importantly, you do not necessarily need to receive SSI or SSDI to qualify for a medical exemption. H.R. 1 also does not directly eliminate SSI or SSDI payment benefits.
States are expected to use information they already have to verify exemptions when possible. However, if your state cannot confirm that you qualify, you may be asked for medical documentation or additional information.
Learn more: Federal Medicaid work requirements and exemptions
Medicaid: Eligibility checks are becoming more frequent
Starting in 2027, people receiving Medicaid through expansion will generally have their eligibility reviewed every six months instead of once a year.
This is important even if you’re exempt from work requirements.
More frequent renewals mean more paperwork, more deadlines, and more opportunities for coverage to be interrupted because of missing information.
What should you do?
Make sure your state Medicaid agency has your current contact information. Open renewal notices promptly, respond to requests for information, and keep copies of anything you submit.
SNAP: Food assistance work requirements have expanded
H.R. 1 also changes who must meet work requirements to keep receiving SNAP benefits. These changes expand SNAP's existing benefit rules for certain adults, commonly called ABAWD requirements (able-bodied adults without dependents).
Under the new rules:
Adults ages 18–64 may now be subject to additional work requirements. Previously, these time-limited benefit rules generally applied through age 54.
Parents whose youngest child is 14 or older may now be subject to the requirements. Previously, having a child under 18 generally provided an exemption.
Veterans, people experiencing homelessness, and young adults who aged out of foster care no longer automatically qualify for exemptions.
What happens if you’re affected?
You generally must work, volunteer, or participate in an approved work program for at least 80 hours per month.
If you don’t meet the requirement and don’t qualify for an exemption, you may be limited to three months of SNAP benefits within a three-year period.
What if you have a disability or chronic illness?
You may be exempt if a physical or mental health condition makes you unable to meet the applicable work requirement. You do not necessarily need to receive SSI or SSDI to qualify for a disability exemption.
Your state may need additional information or documentation to recognize your exemption.
SNAP and Medicaid have separate work requirements and exemption processes. An exemption recognized by one program does not automatically mean the other program has recognized it.
These SNAP changes are already being implemented, so don’t wait until January to check whether they apply to you.
Learn more: USDA SNAP work requirements
Medicaid: Some immigration eligibility rules changed October 1, 2026
Another significant change took effect on October 1, 2026.
H.R. 1 restricts eligibility for federally funded Medicaid and CHIP for some lawfully present immigrants, including some refugees, people granted asylum, and individuals in other humanitarian immigration categories.
This means some people who previously qualified for coverage may no longer qualify under the new rules, even if they have a disability or serious medical condition.
A disability exemption from Medicaid work requirements does not automatically override these separate immigration eligibility restrictions.
If you or someone in your household may be affected, review any notices from your state Medicaid agency and seek qualified assistance promptly.
Other changes may affect your healthcare
H.R. 1 also includes changes that may be less visible but still have significant consequences:
Reduced federal Medicaid funding: States may face additional financial pressure that affects healthcare services, providers, and access to care.
Less retroactive Medicaid coverage: Beginning January 1, 2027, Medicaid will cover fewer medical expenses incurred before the month you apply - unless your state has a special provision (example: Minnesota).
Adults receiving Medicaid through expansion: Retroactive coverage decreases from three months to one month.
People receiving disability-based Medicaid and most other eligibility groups: Retroactive coverage decreases from three months to two months.
This matters if you experience a medical emergency, receive an unexpected diagnosis, or need treatment before you submit your Medicaid application. Waiting to apply could leave you responsible for medical bills that previously would have been covered.
Learn more about retroactive Medicaid coverage changes
Why does this matter for people with disabilities and chronic illnesses?
For many people in our community, Medicaid isn’t simply health insurance.
It’s access to medications, specialists, ongoing treatments, medical equipment, and the support that makes daily life possible.
Losing coverage, even temporarily, can have serious consequences.
And disability doesn’t always mean someone is completely unable to work.
You might work part-time, run your own business, or have periods when your health allows you to work followed by periods when it doesn’t.
Being able to work sometimes doesn’t necessarily mean you can consistently meet stringent work requirements.
For someone with a dynamic disability, 80 hours of work might be manageable one month and impossible the next.
For someone who’s self-employed, business income and working hours may vary significantly.
For someone waiting on a diagnosis, documenting a qualifying medical condition may be more complicated.
The new rules recognize that some people need exemptions. But having a qualifying condition and having your exemption recognized by your state are two different things.
The administrative requirements to meet those exemptions can be very complicated, time-consuming, and make even part-time gainful employment even harder to obtain and sustain.
How do I know if these changes affect me?
Start with these questions.
Do you receive Medicaid?
Find out which Medicaid eligibility category you’re enrolled in.
The new federal work requirements primarily affect people receiving Medicaid through ACA expansion. They do not automatically apply to everyone receiving Medicaid.
People enrolled through certain disability-related eligibility categories, Medicare beneficiaries, and other qualifying groups may be outside the new work requirement.
Check Medicaid changes in your state
Do you have a disability or chronic illness?
You may qualify for a medical exemption, even if you work and even if you don’t receive SSI or SSDI.
Ask your state Medicaid or SNAP agency whether you qualify, how exemptions are verified, and whether you need to provide documentation.
Are you working or self-employed?
Your employment, self-employment earnings, education, or other qualifying activities may help you meet the requirements if you’re not exempt.
Keep records of your work, income, and qualifying activities. If your health affects your ability to work consistently, ask about disability-related exemptions even if you are not on SSDI.
Do you receive SNAP?
Check whether the expanded SNAP work requirements apply to you.
SNAP has different rules from Medicaid, and the changes are already taking effect.
What should I do right now?
You don’t need to become an expert in federal benefits law - the federal guidance and state implementation procedures are evolving nearly every day as states make sense of the new law. But there are a few things worth doing now:
Check your eligibility. Find out whether the new requirements apply to the Medicaid or SNAP benefits you receive.
Ask about exemptions. If you have a disability or chronic illness, find out whether you qualify and how your state verifies it.
Prepare your documentation. Keep important medical records, benefits notices, and employment or self-employment records accessible.
Update your contact information. Make sure your benefits agency can reach you.
Pay attention to notices. Open letters and electronic messages, respond to deadlines, and request accessible formats or assistance when needed.
Important: Some states are not accepting exemption documentation in advance. Preparing your records now is helpful, but follow your state’s instructions about when and how to submit them.
How do I get help?
You don’t have to navigate these changes alone.
There are organizations and resources that can help you understand your benefits, find local assistance, and connect with people who know these systems.
Find out whether Medicaid changes apply to you
CMS Medicaid State-by-State Information
Select your state to review information about upcoming Medicaid changes and find links to your state agency.
USDA State SNAP Agency Directory
Find your state’s SNAP agency to ask about work requirements, disability exemptions, and reporting procedures.
Find local support and assistance
Enter your ZIP code to search for local food assistance, housing support, healthcare, transportation, financial assistance, and other services.
Call 211 to connect with community resources and referral services. This can be especially helpful if you’re not sure where to start or would rather speak with someone.
Find disability-specific support and advocacy
Disability Information and Access Locator (DIAL)
Find disability organizations, Centers for Independent Living, and other community services that may provide navigation, peer support, and advocacy.
National Disability Rights Network
Find your state’s Protection and Advocacy organization. These organizations may be able to help with disability discrimination, access issues, and certain benefits-related disputes.
For Missouri residents
Missouri has published information and a screening tool for people who may be affected by the new Medicaid work requirements.
Missouri residents do not need to submit Medicaid work requirement or exemption documentation right now. The state will first use information it already has and contact recipients if additional information is needed.
Missouri’s published guidance also provides an important distinction for existing Medicaid expansion recipients: qualifying activity or income in at least one month of the six-month renewal period can satisfy the state’s renewal verification requirement.
For Kansas residents
Kansas has not adopted ACA Medicaid expansion. According to CMS, the new federal Medicaid expansion work requirement does not currently apply to KanCare.
However, Kansas residents may still be affected by SNAP changes and other Medicaid provisions.
The bottom line
Don’t assume the new rules apply to you. But don’t assume you’re exempt, either.
Find out which benefits you receive, check your state’s requirements, and make sure you know where to get help.
If you have a disability or chronic illness, you may qualify for protections that aren’t immediately obvious, particularly if you’re working part-time, self-employed, or living with a condition that changes week to week.
Help us keep this resource updated
Have you found a helpful resource, state-specific guidance, or an organization supporting people through these changes? Please share it in the comments!
We’re especially interested in resources that help people with disabilities and chronic illnesses understand their benefits, navigate exemptions, and access support.
We’ll continue updating this article as we learn more, so it can serve as a growing resource for our community.
The more we share, the easier we can make it for everyone to find the help they need.
Disclaimer: This article is provided for general educational purposes and is not individualized legal, medical, or benefits advice. Federal and state policies, implementation timelines, and agency guidance are rapidly changing, and information may be incomplete or outdated, even at the time of publication. The Empower Network does not guarantee the accuracy, completeness, or timeliness of this information. Always confirm requirements with your state benefits agency or a qualified benefits professional before making decisions about your benefits.
