Medicaid: What’s changing and when

New rules for Medicaid are coming in 2026 and 2027.

Here’s what you need to know and what to expect.

Starting October 1, 2026:

1. Immigrant eligibility restrictions: – some lawfully present immigrants who are currently eligible for Medicaid will no longer be able to get regular Medicaid coverage*.
   1. Still eligible for Medicaid: 
      1. Legal Permanent Residents (subject to the five year waiting period),
      2. Cuban/Haitian entrants
      3. COFA Migrants
      4. Lawfully residing children and pregnant women under the CHIPRA 214 option.

*The New Mexico Health Care Authority is creating a coverage program for individuals impacted by these Medicaid eligibility changes. See backside for more information.

Starting January 1, 2027:

2. Renewals: – Most adults ages 19-64 will need to renew Medicaid coverage every 6 months.
   1. Native Americans and other Medicaid recipients are exempt from this change 
3. Work Reporting Requirements: Most adults ages 19-64 will need to report that they are completing 80 hours/month of work, training or community service; enrolled in school half-time; or making at least $580/month.
   1. Must meet requirements one month prior to the month of application or any one of the six months at renewal. 
   2. Many exemptions apply for these requirements (see below). It is important to let the New Mexico Health Care Authority know if you think you qualify for one of these exemptions.
4. Retroactive Coverage: When a person applies for Medicaid, the program has typically covered up to 3 months of medical bills prior to application. Those rules are now changing:
   1. Adults (ages 19-64) – 1 month of retroactive coverage
   2. All other categories (including children and pregnant women): 2 months of retroactive coverage.
5. Work Requirements: 80 hours/month of work, school, training or community service for adults 19-64 eligible for/enrolled in MAGI
   1. Must meet requirements one month prior to the month of application or any one of the six months at renewal. 
6. Qualifying Activities:
   1. Educational enrollment at least half time (high school, GED, college or career and technical education
   2. 80 hours a month of work or community service or work program (SNAP employment and training or another federal, state or local program) or a combination of any of these, including education
   3. Earned/unearned income of $580/month
      1. Seasonal workers, monthly average of $580 over six months
7. Exemptions:

1. Parent, guardian, caretaker relative or family caregiver of a dependent child under the age of 14 or disabled individual
2. Pregnant women or individuals eligible for postpartum medical assistance
3. Entitled to Medicare Part A or enrolled in Medicare Part B
4. Foster youth and former foster youth ages 18 up to 26
5. Nativos americanos
6. Veterans with disability rated as total
7. Medically frail individuals (blindness or disability, substance abuse disorder, mental disorder, significant physical or intellectual disability)
8. Individuals who are participating in a substance use disorder or alcohol use disorder treatment program
9. Individuals who are already in compliance with the work requirements under TANF or SNAP
10. Individuals who are incarcerated or recently released from incarceration within the past 90 days

For more information about these changes and other health care rights, resources, and protections, visit nmtogether4health.org.

Questions? Contact 505-255-2840 or visit nmtogether4health.org.

Created in partnership with the New Mexico Center on Law and Poverty.