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New Medicaid rules are coming. Stay enrolled. Update your contact information today.
New Medicaid rules are coming. Stay enrolled. Update your contact information today.

HR1 Medicaid Changes

Beginning in 2027, new federal rules enacted in HR1 (also known as the One Big Beautiful Bill Act) will affect adults who receive Medicaid coverage through the Affordable Care Act (ACA). The Illinois Department of Healthcare and Family Services (HFS) estimates that nearly 700,000 enrollees may be affected by the policy changes.

Work Requirements

Affected ACA adults must work, go to school, engage in community service, or participate in job training to get or maintain coverage OR qualify for an exemption based on an approved circumstance or condition. Details are below.

Six-Month Redeterminations

After scheduled 2027 redeterminations, all ACA Adult-eligible enrollees will be required to renew coverage every 6 months. ACA adults who are exempt from work requirements are not exempt from 6-month redeterminations.

Get details about policy changes: HFS Federal Resource Center.

Resources for Providers

Providers are the most trusted messengers of health-related information.

Share our step-by-step guide about renewing Medicaid coverage. We’ve updated our interactive tool to reflect the Medicaid policy changes under HR1.

Our quick guide explains how to download a patient list, filter for ACA adult patients, and find redetermination dates within Meridian’s secure provider portals.

Provider portal quick guide: Identifying ACA adult members (PDF)

Get information about Medicaid policy changes, work requirements, redetermination, and ideas to help patients maintain coverage.

HR1 Provider Guidance and FAQ: October 2026 (PDF)

In Illinois, ACA adults who are enrolled by December 31, 2026, must comply with the following during at least one of the 12 months preceding their scheduled 2027 redetermination date:

  • Monthly income of $580 per month or more (different rules for seasonal workers); or
  • At least 80 hours of work per month (work includes a full-time or part-time job, self-employment, seasonal work, and unpaid work like an internship); or
  • At least 80 hours of community service (volunteering) per month; or
  • Participation in a qualifying work program for at least 80 hours per month; or
  • School enrollment (high school, GED, or college or trade school) at least half-time

Note: Any of the above activities can be combined to meet the required 80 hours.

Below are key exceptions and exclusions (not an exhaustive list). Visit the HFS Federal Resource Center for additional information.

  • Individuals with special medical needs (“medically frail”) whose health condition prevents them from meeting work requirements, such as:
    • A blind or disabled person under Social Security standards
    • A substance use disorder (drug or alcohol)
    • A serious mental health condition
    • A physical, intellectual, or developmental disability that makes it difficult to perform activities of daily living
    • A serious or complex medical condition that requires regular treatment
  • Individuals meeting work requirements for Supplemental Nutrition Assistance Program (SNAP) benefits
  • Individuals meeting work requirements for TANF (Temporary Assistance for Needy Families)
  • Individuals experiencing certain kinds of short-term hardship, such as being inpatient in a hospital, rehab facility, or intermediate care facility
  • Caretaker relatives and family caregivers to a person with a disability
  • Enrollees who are pregnant or postpartum up to 12 months
  • Veterans with a total disability rating
  • Former youth in foster care under age 26
  • People recently released from public institutions, like jails or prisons

Subscribe to provider communications, including our Monthly Provider Check-In newsletter, to receive timely updates.

Review Meridian’s provider notices and upcoming provider webinars.