State says 12,850 Alaskans on Medicaid would need to prove they meet work rules

About 12,850 Alaskans on Medicaid would need to send the state proof that they meet new federal work rules to keep their coverage, the Alaska Department of Health estimates.

Health Commissioner Heidi Hedberg and other department officials are scheduled to present the updated figures to legislators Tuesday.

The rules come from H.R. 1, the federal budget law President Donald Trump signed in July 2025. They apply to adults ages 19 through 64 who get Medicaid through expansion, which opened coverage to more low-income adults. Those adults must log at least 80 hours a month of work, school, job training or volunteering, or earn at least $580 a month, which is 80 hours at the federal minimum wage.

Most people in the expansion group wouldn't have to send anything. Of about 57,000 enrolled, the department estimates the rules don't apply to about 34,000, including Alaska Native and American Indian people, pregnant women, people who are medically frail and parents or caregivers of young children. About 9,200 more already earn enough, and a few hundred live in areas with high unemployment.

The 12,850 are the people left over. The state plans to draw on income, benefits and health claims records so fewer people have to send paperwork, and to renew coverage automatically when the records show someone meets the rules.

Missing the hours doesn't end coverage right away. The state must send a notice and give people 30 days to show they meet the rules or qualify for an exemption. In an earlier model from February, which counted more people needing to send proof, the department's two scenarios had half to nearly three-quarters of them losing coverage.

Federal law starts the rules Jan. 1, 2027, but federal officials can give states that show a good-faith effort up to two more years. Alaska has asked for more time, and if federal officials agree, the department plans to start Jan. 1, 2028.

Other changes are still set for Jan. 1, 2027. Many expansion adults will have their eligibility reviewed every six months instead of once a year, and Medicaid will cover fewer months of medical bills from before someone applied.

Compliance checks would run through the state's eligibility system. Department slides warn that delays in essential systems could affect timing and mean more eligibility work done by hand.

The department advises people on Medicaid to keep their contact information current with the Division of Public Assistance so they get notices.