States must implement biannual Medicaid eligibility checks for expansion enrollees under the One Big Beautiful Bill Act

The One Big Beautiful Bill Act requires states to verify eligibility for Medicaid expansion enrollees — adults ages 19–64 who qualified under the ACA expansion — every six months rather than annually, beginning no later than December 31, 2026. States must also implement the law's new 80-hour-per-month work or community engagement requirement for the same population. Together, these changes are projected to reduce Medicaid enrollment by millions. The Urban Institute and KFF projected between 7.5 and 10 million people could lose Medicaid coverage over the next decade from the combined eligibility, work requirement, and verification changes. States that fail to comply with implementation deadlines risk losing enhanced federal matching funds.