Starting January 1, 2027, Maryland Medicaid work requirements and six-month renewals take effect for some adults ages 19 to 64. Maryland estimates the new rules could apply to up to 320,000 members, and the Maryland Department of Health projects that up to 152,000 adults could lose coverage by mid-2028. Much of that loss is expected to come from paperwork, not from people who truly no longer qualify.
For patients living with serious mental illness, losing Medicaid means losing access to the services that keep them stable, including outpatient care, medications, and community-based support like PRP. Here is what is changing, which patients are most at risk, and how your practice and Advocate can work together to keep them covered.
What Is Changing
- Work and community engagement requirement: each month, affected adults must earn at least $580, attend school at least half-time, or complete 80 hours of work, job training, school, or volunteering.
- Renewals every six months instead of once a year for affected adults.
- Proof of a recent month: at renewal in 2027, members must show they met the requirement for at least one recent month.
- Less retroactive coverage for new applications.
Members who were identified as possibly subject to the rules received notices in September 2026. The Maryland Department of Health and Maryland Health Connection have posted details and a screening tool.
The Exemption That Matters Most for Your Patients
Federal law exempts people who are “medically frail,” which includes people with a disabling mental disorder, a substance use disorder, a disability, or a serious or complex medical condition. A federal rule issued in June 2026 narrowed this: a diagnosis alone is not enough. The condition must significantly impair the person’s ability to meet the requirement.
Maryland plans to identify many exempt members automatically, using wage data and health information already available to the state. But where data falls short, expect requests to document how a patient’s condition affects their ability to work. After 2027, members will have fewer chances to simply attest to an exemption, so clear documentation of functional limitations in the clinical record will matter more than ever.
Which Patients Are Most at Risk
The new rules apply to adults covered through Medicaid expansion. Patients whose Medicaid is tied to SSI or a disability determination, and patients who also have Medicare, are generally not subject to the work requirement. The patients to watch are expansion adults who:
- Move often, lack stable housing, or have an outdated mailing address
- Struggle to open, read, or respond to official mail
- Have missed appointments or lost contact with care for weeks at a time
- Rely on SNAP, which has its own expanded work rules
How PRP Helps Keep Patients Covered
PRP works with people in their homes and communities every week, which is exactly where missed notices and expired paperwork happen. With each client’s permission, Advocate’s team helps clients:
- Keep contact information current with Maryland Health Connection and the Department of Human Services
- Track renewal dates and deadlines
- Read notices and understand what they are asking for
- Gather documents such as pay stubs, school records, and volunteer hours
- Use tools like Medicaid Check-In and MarylandBenefits.gov
- Stay connected to SNAP and other benefits
When a client needs documentation of a health condition for an exemption, we coordinate with you as the treating provider. Advocate assists with applications and renewals; clients submit them themselves.
What You Can Do Now
- Encourage patients to update their contact information and check whether the new rules apply to them.
- Share Advocate’s plain-language guide, Keeping Your Benefits, with patients and families.
- Document functional limitations clearly for patients with serious mental illness.
- Consider a PRP referral for eligible patients who are at risk of losing coverage. Our PRP referral checklist explains what you need, and our notice on PRP referrals and Medicaid enrollment covers the enrollment requirements.
Refer a Patient
Submit a referral online. We aim to respond to every referral within 2 hours. Questions? Call our admissions team at (866) 277-2080, extension 2, Monday through Friday, 8:00 AM to 6:00 PM.