Lesson 11
Renewals every 6 months, and copays from 2028
⏱ 2 min
Key points
- For renewals on or after January 1, 2027, expansion adults renew every 6 months instead of every 12.
- Everyone else on Medicaid keeps yearly renewals.
- From October 1, 2028, states must charge copays to expansion adults with income above the poverty level.
- Copays can't be more than $35 a service, and primary care, mental health and community health center visits are exempt.
The 2025 law changed two more things for adults in the expansion group. Neither affects children, pregnant women, older adults or people who get Medicaid through a disability.
Renewals every six months
Medicaid has always had to be renewed, usually once a year. For renewals scheduled on or after January 1, 2027, states must renew adults in the expansion group every 6 months. People in other Medicaid groups keep yearly renewals.
In practice, that means twice as many chances to lose coverage over a missed letter. Your state should still try to renew you automatically using records it has, and send you a form only if it can't. Mark your renewal months on a calendar once you know them, and keep your address and phone number current with your agency. Lesson 12 covers renewals step by step.
Copays starting in 2028
Starting October 1, 2028, states must charge cost sharing to expansion adults whose income is above 100% of the poverty level. CMS says it can't be more than $35 for any one service. Some care is exempt from these charges: primary care, mental health and substance use care, and visits to community health centers. Total out-of-pocket costs for a family can't go over 5% of its income.
Adults with income at or below the poverty level won't have these new copays. Some states already charge small copays for certain services to some people, and those rules continue.
What to do now
Nothing changes for copays until late 2028, so there's no action needed yet. For renewals, the best preparation is the same as for the work rule: make sure your agency has your current address, read every letter, and answer by the deadline.
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