States’ New Consumer Notice Obligations Under Federal Medicaid Work Requirements

Introduction

As states prepare to implement new Medicaid work reporting requirements, consumer notices will play a central role in supporting eligible individuals in enrolling in or maintaining coverage. Consumer notices are the primary mechanism through which state Medicaid agencies communicate requests for information, deadlines, rights and responsibilities, and consequences.

H.R. 1 requires two new Medicaid notices specific to work requirements: (1) an outreach notice notifying everyone currently enrolled in the expansion eligibility group of the new requirements; and (2) a non-compliance notice when an individual has provided insufficient information or not responded to a request for information. These notices are in addition to those required under current Medicaid rules (e.g., eligibility determination and notice of termination) that states will also need to update to reflect the new eligibility requirements of H.R. 1.

Historically, poorly designed or overly complex Medicaid notices have contributed to avoidable coverage loss, confusion, and increased call center and eligibility worker burden. With the complexity of upcoming work reporting requirements layered on top of other major eligibility changes in H.R. 1, including six-month renewals, getting notices right from the outset will be critical to protecting coverage for eligible people. The following lays out key considerations for states as they design, update, and operationalize Medicaid notices related to the new Medicaid work reporting requirements.

Ensuring Clarity and Accessibility

Ensuring that notices are usable and accessible to the people who rely on them is essential. Investing upfront in user-centered, culturally and linguistically appropriate notice design can significantly reduce inappropriate coverage loss and downstream administrative burden.

Notices should be written in plain language (as required under federal rules), clear, and tested with individuals who have lived experience navigating Medicaid eligibility and renewal processes. User testing of draft notices—including individuals with limited English proficiency, disabilities, and varying levels of literacy—will help to ensure that key messages, required actions, and timelines are clearly understood before notices are finalized and deployed at scale.

States must also ensure full compliance with accessibility standards under the Americans with Disabilities Act and provide materials in alternative formats as needed. In addition, notices must be translated into threshold languages and designed to support individuals with limited English proficiency, including clear information on how to access interpreter assistance. Notices must also comply with longstanding due process protections by providing fair hearing rights, aid pending requests (for current enrollees), and timelines for requesting during a hearing.

States’ New Consumer Notice Requirements

Outreach Notice. Prior to the January 1, 2027 effective date, states must conduct outreach to current Medicaid enrollees who will be subject to work requirements. No later than September 2026—and sooner, depending on the lookback period selected by the state—states must send a notice describing how individuals may comply with these new requirements, the consequences of noncompliance, the exemptions to the policy, and how to request an exemption. This notice is also required to be sent out periodically after implementation, the timeline of which is not specified in the statute. The notice is required to be sent by regular mail or electronically, if elected by the individual, and by at least one other modality (e.g., telephone, text message, an internet website, or web portal message).

States should consider beginning outreach to their currently enrolled expansion population before these federal deadlines using as many modalities as possible to support widespread awareness of these forthcoming changes. States may wish to send follow-up notices approximately every three months until an individual’s renewal date to reinforce awareness and preparedness.

In addition to outreach to expansion adults who may be subject to the new requirements, states could communicate with populations that are not subject to work requirements, such as parents of children, individuals over age 65, and people with disabilities. Targeted outreach to these groups can help address confusion as to whether the new requirements apply to them while also reminding them to respond to renewal forms and other requests for information and to update their contact information as needed.

Non-Compliance Notice. After first evaluating whether an individual meets the work reporting requirements or is exempt, including by using ex parte processes as required by H.R. 1 and longstanding federal rules—a state that cannot determine an individual’s compliance or exemption must send a notice of non-compliance to the applicant or beneficiary. This notice must include information on how to demonstrate compliance or show that the requirement does not apply, and how to reapply if the application is denied or the beneficiary is disenrolled.

Individuals must have 30 days, from the date the notice is received, to demonstrate their compliance or exemption. For new applicants, the state may not deny enrollment prior to the end of this 30-day non-compliance notice period. For individuals renewing coverage, the state must continue to provide coverage during this time.    

Importantly, this notice of noncompliance builds upon states’ existing notice obligations at renewal. Per current regulations, if a state lacks sufficient information to complete the renewal through the ex parte process, it must send the individual a pre-populated renewal form and provide a minimum of 30 days for the individual to respond with additional necessary information. The statute does not appear to directly address whether this non-compliance notice must follow the pre-populated renewal form or whether these notices may be issued at the same time. As states consider how to help enrollees navigate these complex and changing requirements, providing these notices sequentially—i.e., providing the prepopulated form, a minimum 30-day period for response, and then, if no response is provided, the notice of non-compliance—would provide individuals with the best opportunity to respond and support continuity of coverage. The expectations for this process remain pending further guidance from CMS.

Summary of Notice Changes

The following table lays out the required content and frequency needed for new notices and existing notices.

Conclusion

As states develop system modifications necessary for implementation of work requirements and six-month eligibility redeterminations, it is critical to prioritize notices and other messaging to enrollees and applicants that clearly explain the new requirement, to whom it applies, who is exempt, if and when any action must be taken, and how to get help. Given the extremely short timeline for implementation, now is the time for states to begin to develop and test notices and other communications to help applicants and enrollees navigate these changes. 

P.L. 119-21, Section 71119.

B.Corallo, A.Diana, Jennifer, Tolbert, Anna Mudumala, and R.Rudowitz, “Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field,” Kaiser Family Foundation, January 10, 2024. Available at ; National Health Law Program, “Major Medicaid Victory in Florida: Federal Court Orders Florida Medicaid to Halt Terminations and Reform ‘Incomprehensible” Notices After Finding Constitutional Violations,” January 7, 2026.  Available at 

; (b).

Health Equity Solutions, “Engaging Enrollees in Medicaid Work Reporting Requirements Implementation,” State Health and Value Strategies, December 2025. Available at

GMMB and Health Equity Solutions, “Preparing Consumers for Changes to Medicaid,” State Health and Value Strategies (February 2026). Available at .

(b).

Id.

.

H.R. 1 requires individuals to satisfy a “lookback period” when meeting work requirements at application and renewal. At application, individuals must demonstrate compliance for the month—or up to three months (as determined by the state)—immediately prior to their application. States that elect a one-month lookback period must send the notice no later than September 1, 2026. States that elect a two- or three-month lookback period must send the notice no later than August and July 2026, respectively.

42 C.F.R 435.916(b)(1).

42 C.F.R 435.916(b)(1).

42 C.F.R. 435.916(2)(A) and (B).

Supra note 8.