Policy & Practice | Spring 2026

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By Jeff Burke, Kate Holman, Betsy Park, and Tiffany Dovey Fishman

Reducing Churn in 2027: Communicating Upcoming Medicaid Community Engagement Requirements

S tarting in January 2027, Medicaid requirements will change for an estimated 20 million beneficia ries. Clear guidance and effective outreach from states can help confirm that eligible beneficiaries do not lose coverage due to missed steps. Under H.R. 1, signed into law in 2025, Medicaid expansion ben eficiaries (Medicaid recipients ages 19–64, up to 138 percent of the federal poverty level, not categori cally eligible) may need to complete at least 80 hours per month of com munity engagement (work, school, training, or volunteering) to maintain their coverage. Certain groups may be exempt (e.g., those with quali fying health conditions, those who are pregnant or postpartum, or those outside the age range). States must implement these provi sions and notify potentially impacted residents. The communications imper ative is straightforward: translate policy changes into clear, actionable steps to reduce potential confu sion or lose coverage due to missed requirements. As time is limited, outreach should be simple, repeated, and delivered across the channels beneficiaries already use.

help identify beneficiaries at higher risk of noncompliance and support persona-based messaging tied to specific actions. Geospatial insights can further focus outreach on priority neighborhoods and connect benefi ciaries to nearby resources (e.g., job centers, nonprofits, events) for in person support. Map the beneficiary journey: Once audiences have been identified, the beneficiary journey for each segment should be mapped, from first hearing about changing Medicaid require ments to ultimately participating in activities to maintain coverage. This helps identify what messages to send at pivotal points in the journey to help beneficiaries navigate challenges such as difficulty finding approved activities or reducing confusion about how to log hours to maintain compliance.

this is a risk-mitigation and cost-sav ings lever for states: timely reminders reduce missed renewals and prevent churn, which can drive administrative rework, increased service demand, and costly re-enrollment. For Medicaid, the cost of a single person “churning” can be as high as $600. 2 An effective omni-channel campaign includes four building blocks: segmenting audiences, mapping the beneficiary journey, reaching people in the moments that matter, and continuously improving performance based on results. Segment audiences: Begin with a clear view of the target audience— their needs, motivations, and barriers. Population insights can then be used to segment beneficiaries and tailor channels and messages to each segment. Demographic, social, economic, and health signals can

Omni-Channel Campaign Approach

Consumers often require multiple touchpoints before taking action, so repeated, consistent outreach across a variety of channels they already use can help to move beneficiaries through onboarding, application milestones, and renewals. 1 Beyond engagement,

Illustration by Chris Campbell

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Policy & Practice Spring 2026