I’m filling out my brother’s Medicaid paperwork as his legal guardian. Below is a comprehensive summary of what I discovered about the recent Medicaid cuts and new requirements in Minnesota—what stays the same, what’s changed, what you must do to keep coverage. Remember Medicaid IS NOT Medicare. Medicaid is a joint federal and state program in the United States that provides health coverage to eligible low-income individuals and families. It is also called Medical Assistance (MA) in Minnesota.

1. What Changed: The Federal “One Big Beautiful Bill Act”

In early July 2025, Congress passed—and the President signed—a sweeping federal bill that includes over $1 trillion in reductions to Medicaid and SNAP over 10 years. These changes take effect in Minnesota starting in 2026, including:

* Mandatory work/community-engagement requirements: Able-bodied Medicaid recipients aged roughly 19–64 must report at least 80 hours of work, volunteerism, job training, or school per month to maintain eligibility.

* More frequent eligibility reviews: Counties must now conduct re‑certifications every six months instead of annually, doubling administrative workload.

* Projected coverage loss: Up to 140,000 Minnesotans (~12% of the state’s Medicaid recipients) could lose coverage. Some estimates go as high as 236,000 when including rural and other vulnerable populations. Funding reductions are expected to cost Minnesota $200 million per year in federal support.

* Work requirements and other changes supply Minnesota’s DHS with flexibility, but implementing these changes will add complexity to the system.

2. Who Is Affected — Who Seems Subject but Is Exempt

What kinds of applicants are subject to the new requirements?

* People aged 19–64, classified as “able‑bodied adults without dependents,” i.e. not earning disability benefits or primary caregivers to children or incapacitated family members.

* Other groups exempt include:

* Pregnant people, the elderly, those receiving SSI/SSDI disability, full‑time students, caregiving parents, and medically frail individuals.

Minnesota DHS data from April 2025: of 560,600 enrollees aged 18–64, about 93,000 had certified disabilities, leaving ~467,600 who could be subject to the work requirement rules.

What percent of the total Medicaid population might be affected?

* Estimates vary: MinnPost reports about 320,000 Minnesotans (~23% of the Medicaid population) may be subject to reporting rules.

* Minnesota Budget Project projects around 436,000 adults (~37% of adult recipients) could need to meet or report work-related hours.

Exemptions and accommodations

Even people who technically qualify for work requirements face risk—not because they are ineligible, but because failure to report hours can result in loss of coverage, even if they work enough hours.

3. Facts: What You Must Do to Retain Coverage

✅ 1. Meet the work/community-engagement threshold

Able-bodied adults must do 80 hours per month, which can be:

* Paid work (wages or self-employment),

* Volunteering,

* Job training, or

* School attendance.

✅ 2. Report the hours timely and properly

* Submit work or engagement hours monthly or quarterly, as required by your county or DHS.

* The rules demand accurate documentation—failure to file or late filing may lead to disenrollment even if you meet the hours.

✅ 3. Complete eligibility reviews every six months instead of annually.

* Counties now must re-evaluate eligibility twice a year.

* If you miss this check-in, coverage may be terminated.

✅ 4. Understand and confirm exemptions (if applicable)

* If you are disabled, pregnant, a caregiver, or medically frail, check that his status is clearly documented to avoid unnecessary work reporting.

✅ 5. Keep detailed records

* Save evidence (pay stubs, training logs, volunteer confirmations, transcripts).

* File reports on time—even if you have the hours, missing documentation hurts.

4. Why Work/Community-Engagement Is a Positive Experience — Not a Penalty

💪 Work builds skills, independence & community ties

* Having a job or volunteer role can increase self-worth, structure, and social interaction—not just income.

* Work or training can lead to longer-term employment stability, access to workplace benefits, and connection to local support networks.

🧠 Mental and physical health benefits

* Studies show employment supports improved mental health and physical well‑being. Contributing to one’s community is motivating and empowering.

💼 Work is already common

* Prior to these changes, nearly two-thirds of working-age adults on Medicaid in Minnesota were already employed. Another ~30% had valid reasons/exemptions (students, caregivers, etc.).

* The notion that Medicaid discourages work misunderstands many recipients: most are already working or seeking work.

✅ Policy goals align—to encourage self-reliance

* Proponents of these policies argue engagement fosters personal responsibility and supports long‑term stability.

* But in practice, many who already meet the requirements risk losing coverage due to bureaucratic hurdles rather than failure to engage.

5. Guardianship Guidance — What to Do as a Legal Guardian

If you’re completing paperwork on behalf of another:

* Clarify their exemption status, if any, on application and renewal forms (e.g. disability documentation).

* Track deadline reminders for reporting and recertification.

* Be proactive in gathering proof of engagement or participation each month.

* If he is protected from reporting, keep written records that age/disability/parental status qualifies him.

6. Key Takeaways and Tips

Topic What You Need to Know

Who is at risk Able-bodied adults aged \~19–64 without children or disabilities may lose coverage without compliance.

Requirements 80 hours/month in work, training, school, or volunteering plus timely report filings.

Reporting deadlines Monthly or quarterly; missing or inaccurate filings can cause loss of Medicaid, even if work is done.

Exemptions Disability, pregnancy, caregiving, age (>64), student status—must be clearly documented.

Coverage reviews Now required every 6 months, doubling administrative burden and stakes.

Work benefits Real work builds independence, income, mental health, and routine—boosting quality of life.

7. Broader Impacts & Warnings

* In states that previously tried similar requirements—Arkansas, New Hampshire—many people who were still eligible lost coverage due to reporting confusion or bureaucratic errors. Coverage loss was significant even when people met the hours.

* In Minnesota, DHS officials warn the added administrative burden may discourage compliance and penalize eligible people.

* Policy analysts note that work reporting does not boost employment—it typically results in coverage loss without increasing job growth or hours worked.

8. Final Thoughts

As you complete your paperwork:

* Document his income, activities, and exemptions carefully.

* Submit all required forms on time—mistakes or delays may cost coverage.

* Keep copies of everything in case of discrepancies.

* Reach out to county caseworkers or advocacy organizations if confusion arises.

* Maintain a routine of engagement, even if it's volunteer or training hours.

By fulfilling you obligations and tracking your status, you ensure the retention of the essential care needed—without penalty, and potentially with new opportunities to thrive.

This shift in federal law marks a major change in Medicaid policy across the country; Minnesota now faces a challenging implementation period. But by understanding what qualifies, keeping thorough documentation, and helping your brother stay engaged, you can protect his coverage.

Thoughtful, well‑informed compliance matters—and remember: work and community engagement are not punishments—they're pathways to dignity, connection, and self‑sufficiency.