H.R. 1 Roadmap: Upcoming Changes to Medicaid

In July 2025, H.R. 1 was passed and signed into federal law. This bill included unprecedented funding cuts and changes to eligibility requirements for Medicaid that could strip nearly 12 million low-income and disabled Americans of health insurance coverage by 2034, according to the Congressional Budget Office. In Illinois, this could result in approximately 535,000 people losing their Medicaid insurance coverage. This reduction in Medicaid funding and access would be particularly devastating for the LGBTQ+ community. According to the Williams Institute, 13% percent of LGBTQ+ adults rely on Medicaid for their primary health insurance, compared to just 7% of non-LGBTQ+ adults. Additionally, approximately 1 in 5 trans patient’s (21%) rely on Medicaid, and 40% of people living with HIV rely on Medicaid for health insurance coverage.

In order to protect access to care, it is critical to learn about how Medicaid will be changing,  how these changes may impact Illinoisans, and how to take action.  

Medicaid Eligibility Changes

• Work Requirements: H.R 1 instated new work requirements as an eligibility requirement for some adults covered by Medicaid. An individual can meet these requirements by being employed, completing community service, participating in a work program, enrolling in an educational program, or a combination of these activities for at least 80 hours per month.
  • Who is impacted: The Affordable Care Act (ACA) expanded eligibility for Medicaid to a large group of adults who were previously ineligible for coverage. These new work requirements generally apply to this expansion population, also called ACA adults, who are: aged 19-64, not receiving Medicare, and not parents or guardians of dependent children age 18 or younger in their home.
  • Who is exempt: Several populations are currently eligible for exemption from work requirements, including: people with a serious and complex health condition, people receiving Supplemental Security Income or Social Security Disability Insurance, caretakers for a person with a disability, people subject to other work requirements in social welfare programs like SNAP and TANF, veterans with total disability ratings, and people recently released from jail or prison.
  • Some states have been rolling this requirement out early. Nebraska began early enforcement on May 1, 2026, while Arkansas, Iowa, and Montana have soft launches and implementation dates set throughout 2026. Illinois will not be rolling work requirements out until Jan. 1, 2027. States also have the option to apply for an extension to delay work requirements further, but these are subject to CMS approval. The federal government released guidance on implementation in June 2026, and more instructions for how to complete work requirements in Illinois will be coming later this year.
• Increased Renewal Frequency: For ACA adults, eligibility redeterminations will switch to once every six months rather than once a year, effective for renewals occurring on or after December 31, 2026.
  • Medicaid enrollees in Illinois will receive paperwork in the mail when it is time for redetermination. Make sure that your current mailing address is on file with HFS to ensure that you receive your paperwork. Enrollees can update their address here: https://hfs.illinois.gov/medicalclients/addresschange.html
  • Redetermination may also be completed online by going to ABE Manage My Case at abe.illinois.gov.
• Immigrant Eligibility:  Starting in October 2026, certain non-citizens and immigrant groups will no longer be eligible for Medicaid. These include: refugees, asylum seekers, and victims of domestic violence and trafficking.

Support and Information in Illinois

Below are resources and action items that will help you stay up to date with Medicaid changes and find assistance should you need it:

• Illinois Department of Health and Family Services (HFS) Webinars: HFS is having a series of webinars to keep people up to date on Medicaid changes. The first webinar, HR1 Module 1: Medicaid Overview and HR 1 Changes, Impact, and Timeline are available to view now. You can also visit HSF to register for upcoming Medicaid webinars.
• Update Your Information: Check and update your address, phone number, and email to ensure you do not miss state mail. You can do this by visiting ABE Illinois Manage My Case.
• Get Covered Illinois: If you lose your Medicaid eligibility, you can find transition and ACA marketplace coverage options via Get Covered Illinois.
• Learn More About Changes: Review state toolkits and guidelines on the Changes Coming to Medicaid page.
• Mail: Keep an eye out for official notices from Illinois Medicaid; open them right away as they will detail any action you need to take.

Phone Support & Hotlines

• Howard Brown Insurance Enrollment Assistance: We offer free insurance enrollment assistance from trained staff members. Appointments are encouraged. You can call 773-388-1600 to get started.
• Direct Assistance Line: Call 1-877-805-5312 to update your contact information, ask questions about your eligibility, and get support regarding the upcoming changes.
• General Benefit & Renewal Help: Call the DHS helpline at 1-800-843-6154 if you need help with your redetermination.
• TTY Line: Users with hearing impairments can reach the state at 1-877-204-1012.