10 ways to help people experiencing homelessness keep their Medicaid
This interactive guide gives health and housing providers a quick overview of upcoming Medicaid changes and practical steps you can take today. Acting now helps ensure unhoused clients maintain their health coverage and care without interruption.
Created by the Stay Covered Coalition | September 2026
New rules. More paperwork.
New federal requirements going into effect on January 1, 2027 will make it harder for some people to get and/or keep their Medicaid coverage, especially people experiencing homelessness.
There are two main changes impacting people who have Medicaid through the ACA Expansion Population (adults 19 to 64 years old, usually without children):
- New Work and Community Engagement Requirements: People must prove they work, volunteer, and/or go to school (A detailed summary of these requirements can be found here).
- More Frequent Renewals: Medicaid member must prove they are still eligible every 6 months instead of once a year.
The risk of losing care
These new Medicaid regulations create severe hurdles for people experiencing homelessness, who frequently face barriers to receiving mail, maintaining identity documentation, accessing reliable technology, and responding rapidly to eligibility notices.
Given the high rates of complex health and social needs within the unhoused population, Medicaid coverage is vital for continued access to health care, behavioral health services, substance use treatment, and housing support.
How to prevent coverage loss
Good news! Many people experiencing homelessness may be excused from the new requirements. This includes people who meet criteria related to medical frailty or who participate in drug or alcohol treatment and rehabilitation programs. Providers can help clients understand if they might be excused and document the information needed to keep them from having to meet the burdensome requirements.
Providers can also help clients meet the requirements when exemptions do not apply, while supporting them in completing their Medicaid renewals on time. By helping clients understand their options, gather documentation, and stay on track with deadlines, providers can help reduce the risk of coverage loss.
Don't wait until 2027
Read about 10 ways to help people experiencing homelessness access Medicaid and stay covered. Help your clients prepare NOW.
01
Know who is impacted
Only the Medicaid ACA Expansion Population (19-64 years old, usually no children) is subject to work and community engagement requirements and six-month renewals. Managed Care Organizations (MCOs) and health providers can use their state’s Medicaid portals to determine which Medicaid category a patient is in.
02
Update clients’ contact information
Help clients create an online Medicaid account and update their address in the portal to manage renewals. Sign clients up for text and email notifications from your Medicaid agency. Report address changes to the U.S. Postal Service so mail can be forwarded. If needed, let clients use a Community Based Organization (CBO) address for USPS mail.
03
Share information with clients and staff
Share and post information widely about the new Medicaid requirements so clients are not surprised when the rules start. Share ways to meet and document the requirements.
Educate staff about the upcoming changes and how they can best support their clients to keep Medicaid coverage.
04
Improve documentation
To help individuals be excused from the work and community engagement requirement, providers should document any substance use disorders, mental illness, chronic medical conditions, and disabilities during client intakes and assessments. Also, document functional limitations that prevent clients from participating in work and community engagement activities. Look out for state guidance on how medical frailty will be documented.
Develop partnerships with local street medicine providers, Health Care for the Homeless providers, FQHCs, and other health care providers who can document and sign off on disabilities and medical frailty.
05
Share data to support renewals
Ask state and local Medicaid agencies to share Medicaid renewal dates with the Continuum of Care (CoC) so housing providers can support timely renewals. Ask MCOs for the same data.
Prepare to share data that documents the exclusions — such as medical frailty or participation in drug or alcohol treatment or rehabilitation programs — that may excuse clients from work and community engagement requirements.
06
Help with applications, renewals, and verification
If your state has a portal that allows CBOs to help clients apply for and manage Medicaid, register for it. Track when clients’ renewals are due.
Provide clients with access to computers/smart phones to complete renewal and application forms.
Document and advocate for clients to be excused from the work and community engagement requirements whenever possible.
07
Help clients meet work and community engagement requirements
For individuals who may not be excused from the new requirements, document when clients are working, volunteering, etc. Plan to record client activities, dates, and hours spent working and volunteering, and assign a point of contact. Leverage work that is common in the homeless system, like LEAB participation, peer navigation, doing in-kind work at a homeless shelter, etc.
Build partnerships with local workforce agencies, job training programs, and adult education programs to support clients’ employment and education.
08
Help clients apply for disability benefits
Medicaid members with Social Security Supplemental Security Income (SSI) are exempt from new requirements. Determine if clients may be eligible for SSI based on a disability or health condition. Start connecting clients to SSI-advocates and benefits assistors. Learn how to document a disability to support successful SSI applications.
Consider if your client is eligible for Aged, Blind, and Disabled Medicaid, as individuals enrolled in this program also will be exempt from new requirements.
09
Find community partners
Health clinics, hospitals, managed care organizations, street medicine providers, homeless shelters, street outreach teams, adult education programs and workforce programs are just a few of the partners who have an important role to play in keeping people covered.
Find local community partners who can help with outreach efforts, document medical frailty, provide job training, and more. Develop regional hubs for sharing volunteer, work, work program, and education opportunities. Build referral partnerships. No one has to do this alone.
10
Speak up and join us!
The voices of providers and people with lived experience of homelessness are vital in this effort. Get involved at the state level to make sure that policy and implementation of these new rules reflect the realities of people experiencing homelessness. Sign up to receive notifications of new tools and events from the Stay Covered Coalition.
The Stay Covered Coalition formed in 2026 to address unprecedented threats to Medicaid coverage for Californians experiencing homelessness.
The Coalition will share tools and best practices with stakeholders and providers to support efforts that help unhoused Medicaid members maintain coverage in California and nationwide.
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