The People’s Health and Wellness Clinic in Barre in July 2020. File photo by Glenn Russell/VTDigger The first of a series of changes to Medicaid is set to take effect Oct. 1, put in motion by the federal budget bill passed in July 2025. The next round of changes begins in January. Combined, the changes to the state-federal health insurance program are expected to affect nearly 50,000 Vermonters, but that doesn’t mean that all will lose coverage, say healthcare advocates and Medicaid officials. Rather, it will be a major bureaucratic lift to keep those people insured. “Everything we’ve been doing as far as implementation of (the federal changes) is built towards the mindset of ‘How do we maximize the amount of people who retain coverage through these changes, and how do we support them through what are ultimately very major changes to the Medicaid program?’” said Alex McCracken, the director of communications at the Department of Vermont Health Access, which oversees Medicaid in the state. The Oct. 1 changes will prevent certain immigrants from receiving Medicaid.  Most adult refugees and asylum seekers in Vermont will lose Medicaid; the state estimates that’s about 235 people. The exceptions are lawful permanent residents; immigrants from Cuba, Haiti, Micronesia and the Marshall Islands; pregnant people; and anyone under 21.  Unless they’re able to get insurance through an employer or a spouse, the refugees and asylum seekers losing insurance will have few other options for coverage.  “Honestly, it will be really devastating and hard for this small set of people,” said Mike Fisher, the state’s healthcare advocate.  The second round of changes will begin at the start of 2027 and apply to a much broader group of Medicaid recipients ages 19 to 64. This population will need to show that they make at least $580 a month while still earning under the Medicaid income threshold of 138% of the federal poverty level. If a person doesn’t make $580 monthly, they must attest to spending 80 hours a month on work, education or community service. They will also need to renew their Medicaid eligibility every six months instead of annually.  The state estimates that 49,000 Vermonters will need to meet these requirements to retain coverage. Fisher said that his office, which runs a healthcare help line and has guidance materials for those trying to navigate the changes, has fielded concerns about children or Medicare patients losing coverage. Those groups will not be affected, he said. He added that many people are exempt from the January rule change and will not need to meet the new earnings, work and documentation requirements.  Pregnant people, Indigenous people and those who are medically frail or eligible for federal food benefits are exempt. So are veterans with a disability and anyone who is otherwise eligible for Medicaid despite being incarcerated. Parents of children under 13 and any family caregiver are also excluded from needing to meet the January requirements.  “People shouldn’t lose their Medicaid due to failure to meet the work requirement, but they may and will lose their Medicaid because they don’t manage to get the right piece of paperwork,” Fisher said, adding that those without a home address may be most likely to struggle with the paperwork requirements.  McCracken said the department is working to get information out to its beneficiaries in an array of languages, in videos and through community organizations. In the state’s 2026 budget, the department received funding for 12 new staffers meant to handle the new eligibility requirements. The Department of Vermont Health Access is also working to collect whatever state and federal data it has — information including wage data, work-requirement reporting for food assistance, data on incarcerated people and veterans — to keep people from needing to self-report.  The Vermont Afghan Alliance, which works with Afghan immigrants in Vermont, has hosted a health insurance clinic with Vermont Legal Aid to try to prepare people for the changes. It has also connected people with Medicaid assisters and used its community WhatsApp channels to help people understand the changes and the options available to them. Many of the resources have been available in the Dari and Pashto languages, said Ellen Yount, the alliance’s director.  Most of the Afghanis in the alliance are in Vermont on special permanent immigrant visas they received for working with the U.S. government during the war and military occupation of Afghanistan. Because of that permanent lawful status, those on Medicaid won’t lose their coverage Oct. 1 but they will still need to meet the work requirements. Still, some Afghan asylum seekers without special permanent status will lose health insurance.  READ MORE The state is working with Vermont’s free clinic system to identify who can take newly uninsured patients at a low cost. Melanie Clark, a Medicaid assister at the Open Door Clinic in Middlebury, said it’s likely many of the people losing Medicaid coverage will have low enough incomes to qualify for financial assistance in federally qualified healthcare clinics or with hospitals’ emergency rooms or urgent care facilities.  “It’s not going to be a true health insurance plan,” she said. “It just won’t be through Medicaid. It’ll likely be through one of these other avenues.”  Her clinic is ready for an influx of patients, but also prepared for patients to seek care elsewhere, she said. It’s a scenario the clinic saw play out with the expiration this year of the advanced premium tax credits that helped people afford coverage on the Affordable Care Act marketplace. McCracken also worried about the strain that a surge in uncompensated care could have on a healthcare system unprepared to absorb the loss of income. In recent hospital budget hearings, many of Vermont’s hospitals raised concerns about an increase in uncompensated care as more Vermonters drop marketplace coverage. Read the story on VTDigger here: Vermont Medicaid braces for new rules coming for nearly 50,000 Vermonters. ...read more read less