# Medicaid Moves Expansion Adults to Six-Month Renewals Starting January 2027

Canonical URL: https://nemtguide.com/news/medicaid-six-month-renewals/ · Updated 2026-09-28

Starting with renewals scheduled on or after January 1, 2027, every state that covers the Medicaid expansion group must check those adults' eligibility every six months instead of once a year. Section 71107 of Public Law 119-21, signed July 4, 2025, made the change, and the Centers for Medicare & Medicaid Services (CMS) told states how to carry it out on March 6, 2026. More renewals mean more chances for a rider to lose coverage over a missed letter, and when coverage ends, so does the Medicaid ride benefit.

## Key dates

| Date | What happens |
|---|---|
| July 4, 2025 | Public Law 119-21 becomes law |
| November 18, 2025 | CMS summarizes the law's Medicaid changes for states |
| March 6, 2026 | CMS issues State Medicaid Director Letter SMD 26-001 on six-month renewals |
| January 1, 2027 | New expansion enrollees get six-month coverage periods, and renewals scheduled from this date use the six-month cycle. It is also the latest start date for the work requirement in states without a CMS-approved delay. |
| January 4, 2027 | Earliest practical date a state that moves renewals up can start them |
| March 31, 2027 | Deadline for states that cover the group in their state plan to file the plan change for six-month renewals |

## Who moves to six-month renewals

The rule covers the Medicaid adult group created by the Affordable Care Act. Virginia describes it as adults 19 to 64 with income under 138 percent of the federal poverty level who are not eligible for Medicare. CMS says about 20 million people were enrolled in this group in fiscal year 2025.

| Rider | How often Medicaid is renewed from 2027 |
|---|---|
| Expansion adult, 19 to 64, not pregnant, no Medicare | Every 6 months |
| Adult in the expansion group covered through a section 1115 waiver that covers the whole group | Every 6 months |
| American Indian or Alaska Native in either group | Every 12 months |
| Rider in another income-based group, such as a child, a pregnant member, or a parent or caretaker relative | Every 12 months |
| Rider eligible through SSI, age 65 or older, blindness, disability, or long-term care | At least every 12 months |
| Rider with Medicare Part A or Part B | Not in the expansion group, so the rule does not apply |

The rule does not apply in the territories, or in states that cover only part of the expansion group through a waiver.

## How a renewal works

The law changed how often states renew, not the steps. Under CMS rules, including 42 CFR 435.916, the state must:

1. **Try to renew from its own data first.** This is an ex parte renewal, and the rider does nothing.
2. **Send a prefilled renewal form if that fails.** The rider gets at least 30 days to correct it, sign it, and send it back with any papers the state asks for.
3. **Check every other way the rider might qualify** before ending coverage.
4. **Give at least 10 days' notice** and the right to a fair hearing before coverage ends.
5. **Reconsider without a new application** if a rider cut off for missing paperwork sends the form within 90 days after coverage ends.

CMS says most states take 60 to 90 days to finish a renewal, so someone on a six-month cycle may be only about three months into coverage when the next renewal starts.

## When current members switch

People who apply and start coverage on or after January 1, 2027 get six-month coverage periods from the start. For members already enrolled, CMS gave states two options:

| Option | What the state does | Example from CMS |
|---|---|---|
| 1. Move renewals up | Moves 2027 renewals earlier, starting as early as January 4, 2027, and shortens current 12-month periods with at least 10 days' notice | A member covered May 1, 2026 to April 30, 2027 is renewed starting January 4, 2027 |
| 2. Switch at the next renewal | Keeps each member's 2027 renewal date and grants six months at that renewal | A member covered August 1, 2026 to July 31, 2027 renews on schedule, then gets six months from August 1, 2027, with the next renewal set for January 31, 2028 |

States are choosing now. Virginia says current expansion members move to six-month periods starting with their first renewal in 2027. Pennsylvania says current recipients switch after completing their next renewal in or after February 2027. Your state Medicaid agency posts its own plan.

## Why it can cut rides

- **Coverage ends, and rides end with it.** Federal rules at [42 CFR 431.53](https://www.ecfr.gov/current/title-42/section-431.53) require states to ensure necessary transportation for Medicaid members to and from their providers. A rider who loses Medicaid loses the ride benefit, and a trip booked weeks ahead can outlast the coverage.
- **Two checks at once.** Many of the same adults must also show they meet the work requirement at each renewal on or after January 1, 2027. See the [Medicaid work requirement rule](https://nemtguide.com/news/medicaid-work-requirement-rule/).
- **Less back coverage.** For applications on or after January 1, 2027, an expansion adult who reapplies gets at most one month of coverage before the month of application, down from three under the old federal rule. Other members get up to two. Trips during a longer gap cannot be covered.
- **Recurring riders are exposed.** Riders on standing orders, such as three rides a week to treatment, lose the most trips when coverage lapses. A dialysis rider who has Medicare is not in the expansion group, so the six-month rule does not apply to them.

## How to check eligibility before each trip

1. **Check on the day of the trip, not only when it is booked.** Use your state's provider portal or your broker's tool. See [Medicaid eligibility verification](https://nemtguide.com/glossary/eligibility-verification/).
2. **Recheck standing orders every month.** A rider can lose coverage halfway through a series. Our standing orders guide covers how recurring trips are set up.
3. **Ask your brokers how they handle it.** Find out what happens to a trip already assigned to you when the member turns out to be ineligible on the day of service.
4. **Remind riders about their mail.** Virginia tells members to check mail, email, and texts, keep their contact details current, and answer requests quickly. A rider who mentions a renewal letter should send it back before the deadline.
5. **Point cut-off riders to the 90 days.** If a rider who lost coverage for missing paperwork sends the renewal form within 90 days after coverage ends, the state must reconsider eligibility without a new application.
6. **Ask about Medicaid at intake.** Our trip intake guide lists the questions to ask when a trip comes in, and [claim denials](https://nemtguide.com/guides/nemt-claim-denials/) covers what to do when a trip is denied for eligibility.