Confusion around how to adhere to new Medicaid rules persists, survey shows

With just over two months before Medicaid work requirements go into effect, new surveying from Aeroflow Health, a durable medical equipment company, shows members are not prepared to submit documentation -- and are unsure if they even have to.

The survey of 1,000 Medicaid members showed general knowledge of the Medicaid work requirements was getting better, with 63% of respondents saying they were aware of the requirements. That's an improvement from the 80% who said they were unfamiliar with the work requirements in an August 2026 poll from the National Alliance on Mental Illness and Ipsos.

Still, Medicaid members cite a lack of clarity around the so-called community engagement guidelines, which require Medicaid enrollees to verify 80 hours of work, schoolwork, caregiving or volunteer work per month to maintain their coverage. Some exemptions exist, such as for those with medical frailty, but critics of the requirements say it's not clear how enrollees can attest to their medical frailty.

According to Casey Hite, Aeroflow Health's CEO, the lack of clarity risks coverage for Medicaid members who do fulfill the work requirements.

"People should not lose Medicaid coverage because the reporting process was confusing, especially when they have met the requirements or qualify for an exemption," Hite said in the press release. "That is the risk our findings expose. Awareness is not readiness. Members need to know whether the rules apply to them, what information is required, and exactly how and when to submit it. One general notice will not be enough."

As it stands, the process for submitting work requirement documentation is opaque, with 44% of respondents reporting feeling unprepared to submit it.

What's more, members are unsure who's even subject to the work requirements. Indeed, a third of respondents said their biggest concern about the Medicaid work requirements was determining whether they'd be affected. Another 37% told the surveyors that they are exempt from the work requirements because of disability, caregiving responsibilities or another program status. However, the report pointed out that this self-attestation does not necessarily mean they qualify for legal exclusion.

That's not all. Members are worried about their health status and ability to afford their healthcare once the work requirements go into effect.

Around half (53%) of respondents said they've already made changes to their healthcare access due to coverage concerns. Another 89% said they were at least somewhat concerned about affording their health services and medical equipment once the work requirements go into effect.

This data indicates a clear lapse in communication, the report indicated. Just under half (46%) of respondents said they hadn't received any reminders about the work requirements, and 42% said they'd only received around one or three reminders.

Medicaid agencies need to readjust their outreach efforts to prevent members from falling off the Medicaid rolls and to ensure new members meet the eligibility requirements, the report advised.

Foremost, agencies need to clarify who is subject to work requirements and how to qualify for an exemption. This must be complemented by clear instructions for submitting documentation and reporting of meeting community engagement guidelines. All member communications should follow best practices for health literacy and be available in members' preferred language.

Stakeholders should also increase the volume of communication and prioritize members' preferred channels: text message, email and phone call. Organizations might also consider expanding access to member navigators to provide personalized assistance.

Finally, states must focus on both current members and potential applicants for communication and navigation. This mitigates the risks of people losing their current coverage and struggling to enroll in the first place.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.