In 2025, Congress enacted Public Law 119-21 (H.R. 1), which made sweeping changes to Medicaid, including a new work reporting (“community engagement”) requirement for some individuals covered by Medicaid expansion. Starting in 2027, many of the impacted individuals will have to participate in 80 hours a month of some combination of work, job training, education, or community service. Recognizing that work reporting requirements are not appropriate for all populations, the law created a number of exemptions so that people in certain circumstances will be able to maintain their coverage whether or not they can prove they are participating in community engagement activities. However, how these exemptions are applied will significantly impact whether people with mental illness can keep their Medicaid coverage.
This brief, a joint effort from NAMI and the Legal Action Center, provides recommendations to policymakers on strategies to protect individuals with mental health conditions from losing Medicaid coverage under these new work reporting requirements.
