New federal requirements resulting from the July 2025 passage of the “One Big Beautiful Bill Act” (known as “OB3”) make fundamental changes to Medicaid eligibility. Under these changes, certain adult Medicaid members must comply with new and complex work reporting requirements and will be required to prove their eligibility every six months rather than annually.

The work requirements will impact adults age 19-64, with exemptions if:

• They are pregnant;
• They are a parent, guardian or caretaker of a child under age 14 or someone with a disability;
• They are medically frail;
• They participate in a substance use treatment or rehab program; or
• They meet another exemption identified by the federal government*

Previous BCBSMA Foundation research estimates that work requirements and more frequent redeterminations could result in 141,000 to 203,000 MassHealth members losing coverage. Early evidence from the handful of states that have previously implemented work requirements suggests that large numbers of eligible individuals will lose coverage due to being uninformed or facing administrative obstacles, rather than ineligibility.

Outreach and engagement campaigns are a critical component of state efforts to ensure eligible individuals who are impacted by work requirements and more frequent renewals can keep their health coverage. To help inform those efforts, this issue brief provides actionable recommendations for how MassHealth and its implementation partners – health care providers, MassHealth’s Accountable Care Organizations and Managed Care Organizations, community-based organizations, faith-based organizations, advocacy organizations, and others – can minimize preventable coverage loss from these new federal Medicaid requirements through effective outreach, engagement, and enrollment assistance. An accompanying executive summary highlights the key recommendations.

Specific to older adults, the BCBSMA Foundation Report offers the following:

“While many older adults and individuals with disabilities will be exempt from work requirements and six-month renewals, they may experience confusion or anxiety about how the changes affect them. Further, individuals with disabilities who are not enrolled in MassHealth on the basis of that disability may face challenges in documenting exemptions. Paper-based and telephone communication and application options should be maintained for these populations, and messaging should be in plain language and accessible formats. Elder services agencies (e.g., Aging Services Access Points), disability organizations such as Independent Living Centers (ILCs), state agencies (e.g., MassAbility), and other specialized providers should lead outreach to these populations, and MassHealth and implementation partners should proactively identify individuals who may qualify for exemptions using available data.”

More detail is available in the full report here.