New Medicaid work rules are coming. 600,000 Oregon Health Plan members are getting notices.

By KRISTINE DE LEON/The Oregonian/OregonLive

Oregon has begun sending letters to about 600,000 Oregon Health Plan members warning them about new requirements taking effect next year that potentially impact their eligibility for Medicaid benefits.

For many, the letter will be more alarming than consequential.

Some recipients already meet the new rules requiring them to work, attend school or volunteer enough hours each month. Others won’t have to meet them at all because they are pregnant, caring for a young child, have serious health conditions or qualify for another exemption.

But Oregon is sending notices broadly because federal rules require the state to warn adults who could potentially be subject to the requirements — even if the state already knows they won’t be.

That means a parent caring for a 6-year-old or someone already working enough hours — both of whom are exempt from new work requirements — may get a warning letter, said Vivian Levy, the Oregon Health Authority’s interim Medicaid director. 

For about a third of those getting a notice, Oregon doesn’t yet have enough information about whether they meet the rules or qualify for an exemption, Levy said.

OHP covers about 1.4 million Oregonians, meaning more than 40% of members are receiving one of the notices.

Starting Jan. 1, some OHP members will have to meet a new monthly work requirement to get or keep their coverage. The rules largely apply to low-income adults who became eligible for Medicaid when Oregon expanded the program through the Affordable Care Act. The requirements stem from the sweeping tax and spending law that President Donald Trump signed last year.

People subject to the rules generally must spend at least 80 hours a month working, volunteering, attending school or participating in job training. Attending school at least half time or earning at least $580 a month also counts.

Current OHP members won’t all undergo that eligibility review Jan. 1. Oregon will check when they come up for renewal, meaning some won’t encounter the new requirements until later next year or early 2028.

And for now, officials say, people receiving the letter this month don’t need to respond.

“Your coverage will not end at this time due to work or activity rules,” Levy said.

The bigger challenge comes when Oregon has to determine who actually meets the rules.

The state plans to check as much as it can automatically. OHA can use wage and other electronic records to determine whether someone is already meeting the requirements and identify some people who qualify for exemptions, sparing many members from submitting paperwork.

But the state won’t be able to verify everyone automatically. Medicaid hasn’t historically collected all the information the new federal rules require, according to testimony state officials gave lawmakers earlier this month.

That means some members may eventually have to provide a pay stub, volunteer log or other documentation when they apply or renew.

Sorting out who qualifies for a medical exemption can also be tricky. Oregon plans to check Medicaid records for certain diagnoses in hopes of identifying some people automatically.

But having a diagnosis doesn’t necessarily make someone exempt. Federal regulators have told states that a medical condition must significantly impair someone’s ability to meet the work requirement, state officials told lawmakers.

For the first year, members generally won’t have to prove they qualify for an exemption. More will need documentation starting in 2028, though OHA is still waiting for federal guidance on what proof will count.

Oregon can’t yet estimate how many people who qualify for Medicaid could nevertheless lose coverage because they miss paperwork or a deadline, Levy said.

That risk of coverage losses could increase as eligibility checks become more frequent. Many OHP members currently keep coverage for two years between renewals. Starting in late 2027, many adults subject to the work requirements will have to renew every six months.

Health policy researchers say the confusion could reach beyond the adults directly affected.

Dr. Daniel Nelson, an Oregon Health & Science University physician and Medicaid researcher, told The Oregonian/OregonLive earlier that he worries parents who lose their own coverage could mistakenly assume their children have been disenrolled, too, and stop seeking care.

Researchers say similar confusion has surfaced elsewhere. After Indiana tightened Medicaid eligibility checks last year, enrollment fell among adults and children. The state’s Medicaid director told Bloomberg Government that one possible reason for the drop among children was that parents who lost Medicaid failed to enroll children who were still eligible.

Oregon health officials say they have trained about 1,700 people at 400 community organizations to help members navigate the changes.

For now, the most important thing OHP members can do is make sure the state knows how to reach them. Members can update their contact information at Benefits.Oregon.gov, call 800-699-9075 or visit an Oregon Department of Human Services office. 

This story was originally published on Sept. 22, 2026 by The Oregonian/OregonLive.