What Advocates Need to Know to Help Survivors Maintain Coverage
By Kiersten Stewart, VP Policy & Advocacy
November 12, 2026
Last year, Congress passed H.R.1, a bill that will go into effect January 1, 2027. The legislation is bringing significant changes to Medicaid, which is health insurance for people who are low-income, elderly, or have a disability.
The changes will impose new work and documentation requirements that will make it harder for many current recipients to access the healthcare they need. A new Congress will be sworn in in January, and many of the new leaders have mentioned restoring cuts to Medicaid as a priority, but as of now, these changes will take effect.
While the new law doesn’t specifically target domestic violence or sexual assault survivors, we know the new requirements will affect many survivors.
- Intimate partner violence is 2.5 times as prevalent among Medicaid patients as among non-Medicaid.
- Survivors often rely on Medicaid after leaving an abusive relationship or losing employment due to their abuse.
- Access to Medicaid helps survivors heal from their trauma and injuries, and it is often their only pathway to receive medical treatment or mental health counseling for themselves or their children.
- Healthcare providers are essential in connecting survivors to domestic violence and sexual assault programs and other community-based resources.
- Survivors who talk to their health care provider using the CUES Intervention are more likely to experience less violence.
What do advocates need to do to prepare for these changes and ensure survivors can still access the much-needed and at times life-saving Medicaid?
What are the changes?
These are the two overarching changes to Medicaid:
- Starting January 1, 2027, adults in every state except Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming will be required to do 80 hours a month of work or community engagement or be enrolled in high school, higher education, career, technical education, or high school equivalent programs in order to keep their Medicaid. (Nebraska and Montana have already implemented the changes, and Iowa will start implementation on Dec. 1.)
- Documentation will be required every 6 months to prove eligibility for Medicaid. This Increase in paperwork will be an added burden for survivors who may be experiencing unstable housing or partners’ sabotage of employment or other issues related to their abuse.
Not only is the threshold of 80 hours a month of documented work or community engagement a challenge for a survivor, but the process of documenting the work will be a challenge as well.
Through our Survivors Health Access Project, Futures Without Violence (FUTURES) has been working to provide advocates with resources to help them understand the new law. We have held multiple online briefings since launching the project, reaching hundreds of advocates and survivors to inform them about the Medicaid changes.
We want to make sure advocates have the information they need to help survivors keep their Medicaid. Many survivors should be able to do that, but it will take knowledgeable staff and connections to resources to navigate these changes.
What Can Advocates Do?
From learning the basics about the new law to ensuring survivors can receive Medicaid notices, domestic violence and sexual assault program staff can help survivors prepare for the changes. FUTURES created a month-to-month checklist that is available here.
Among our top recommendations:
- The most important step is to start now to help survivors understand if they are on Medicaid and what kind. Partnering with your local health care agency or community health center is a great place to start. You can find information on your state’s Medicaid program here.
- Learn what defines work, community service, work programs, and education programs. We have an easy-to-understand fact sheet about these changes here.
- There are a number of populations that are exempt from work requirements. Survivors as a group are not exempt, but they may fall into other categories that are. FUTURES created a checklist of these exemptions here.
You can help survivors get the healthcare they need so they can heal, and their families can thrive. And we can help. Sign up to join our mailing list (select Policy & Advocacy) or reach out to us with any questions: policyadvocacy@futureswithoutviolence.org.
