Beginning October 1, 2028, H.R.1 requires states to impose co-payments for services provided to Medicaid expansion adults with income above 100% of the federal poverty level. This toolkit is intended to support states in understanding and implementing H.R.1’s new copay requirements for certain Medicaid expansion enrollees that meet specific income requirements. The toolkit provides an overview of the new copay requirements and proposes an operational approach to ensure compliance with federal requirements and reduce states’ administrative burden and potential barriers for members.

This messaging guide supports state Medicaid agencies in communicating with residents—including enrollees and applicants—about the implementation of work reporting requirements under H.R.1. It is designed to help states and other partners communicate clearly and consistently about what people need to know now—what’s confirmed, what’s still being decided, and how states and partners will support them through transitions. This is Part 1; we expect to release updated messages (Part 2) as additional federal guidance is finalized. Translations of these core messages are forthcoming.

This resource is intended to support states as they explain work reporting requirements in H.R.1. It is designed to help states create clear, linguistically and culturally appropriate materials for people enrolled in or eligible for Medicaid. Each term includes a plain-language definition, alternative ways to explain it, and guidance on why clarity matters. Using consistent, clear terms can help reduce confusion, build trust, and enable enrollees or applicants to better understand what’s expected of them.

The Centers for Medicare & Medicaid Services Access Rule (§ 431.12) requires states to publish an Annual Medicaid Advisory Committee Report, a critical component of which is a distinct section dedicated to describing the activities of the Beneficiary Advisory Council (BAC). The first of these annual reports is due by July 9, 2026.

This toolkit includes a variety of resources to guide states in creating and formatting the BAC section of the Annual Report, including:

• [Download] BAC Annual Report Guide: A strategic framework for the BAC section of the Annual Report that demonstrates how states can adhere to the mandated reporting elements while also facilitating a meaningful feedback loop among key stakeholders.
• [Download] BAC Annual Report Template: A customizable Annual Report outline that frames potential report sections and offers detailed guidance on the information needed to meet requirements. Designed to be flexible, allowing states to modify the structure to fit their specific needs.
• [Download] BAC Effectiveness Assessment Survey Tool: A resource designed to evaluate the quality of BAC engagement, featuring a ready-to-use survey instrument and data collection guide.

States can customize and brand any of the tools included in this toolkit, or for additional customization support please contact SHVS. Also refer to the SHVS Medicaid Beneficiary Advisory Council Reporting Toolkit for additional resources designed to support state Medicaid agencies in proactively collecting and documenting BAC activities.

As states seek to make health insurance more affordable, State-Based Marketplace subsidies are a potential solution to help Marketplace consumers pay for coverage. This issue brief explores reasons states consider subsidies, design options, and state action to date. This resource is for state policymakers considering whether to create a subsidy and how to structure it. 

On Friday, February 27, State Health and Value Strategies hosted a webinar analyzing the annual proposed 2027 Notice of Benefit & Payment Parameters (NBPP). The proposed NBPP includes a broad set of policy and operational changes for 2027 which: implement elements of the 2025 budget reconciliation law H.R.1; roll back some current policies; revisit provisions of the Marketplace Integrity final rule; and introduce several new policies.

During the webinar, SHVS experts reviewed the proposed rule and discussed key operational and policy considerations for state Marketplaces and departments of insurance. The webinar also included a question and answer session during which attendees posed their questions to the experts on the line. For more information, see the new SHVS issue brief, Proposed Marketplace and Insurance Changes in the 2027 Notice of Benefit & Payment Parameters: Implications for States.

On Thursday, February 19, State Health and Value Strategies hosted a webinar on communicating the new work reporting requirements under H.R.1. This federal mandate marks a major shift in how Medicaid operates and how consumers access and maintain their coverage. While a major undertaking, a robust communications and outreach strategy can help states protect coverage for eligible enrollees and support broader operations as they roll out these new requirements.

During the webinar, experts from GMMB provided an overview of key H.R.1 provisions related to communications and walked through a communications workplan to support outreach on the new reporting requirements. The framework is designed to help states build or refine their communications efforts, identify gaps, and remain nimble. During the webinar, experts from Health Equity Solutions also shared recommendations from the toolkit Engaging Enrollees in Medicaid Work Reporting Requirements Implementation and highlighted ways states can involve people enrolled in Medicaid in communications planning and message development.

Starting January 1, 2027, individuals enrolled in the Medicaid expansion group or similar coverage must either meet work or community engagement requirements or qualify for an exemption to keep their coverage. This federal mandate marks a major shift in how Medicaid operates and how consumers access and maintain their coverage. For the first time, many will need to actively document and report work, school, or volunteer activities to stay enrolled.

This workplan is designed for state Medicaid and health and human services communications staff—particularly those responsible for planning and executing outreach related to new work reporting requirements. States can use it to inform the creation of communications efforts or to cross-reference existing plans, ensuring key tactics are considered, gaps are identified, and strategies are aligned around maintaining coverage for eligible people enrolled in Medicaid.

H.R.1 makes sweeping changes across the Medicaid program, including major shifts in enrollment, eligibility, expenditures, and operations. To understand these impacts, it is imperative that state officials develop a monitoring strategy. This issue brief outlines the strategic case for investment in monitoring, provides a phased action timeline for states to implement monitoring activities, and details potential priority monitoring domains. By pairing real-time early warning data with long-term outcome analysis, states can link observed trends, such as coverage loss, directly to specific policy drivers. Ultimately, a robust and standardized monitoring strategy creates the necessary record to understand the true fiscal and human costs of these changes as they unfold.