A team of nine Brown University students is preparing to help Rhode Islanders navigate Medicaid eligibility changes as new rules take hold. More than 30,000 Rhode Islanders could be affected by the changes tied to the One Big Beautiful Bill Act, and the students are positioning themselves as a resource for anyone confused by the new paperwork.
The initiative, known as the Medicaid Student Fellows Program, comes from the People, Place and Health Collective at Brown University, which plans to use the fellows to educate Rhode Islanders about the changes, according to The Boston Globe. Brown’s School of Public Health has assembled nine student fellows to help local Medicaid recipients navigate the shifting rules, the newspaper reports, and the program drew 45 applicants for those nine positions. The fellows are preparing to help recipients navigate the changes.
Crucially, the students are not just handing out pamphlets. The fellows are certified application counselors in Rhode Island, meaning they can directly assist with Medicaid applications and renewals rather than simply pointing people toward a hotline. The outreach is funded through the Rhode Island Executive Office of Health and Human Services and the Brown School of Public Health, per the same report.
Who the Fellows Are Trying to Reach
The fellows are focusing their energy on unhoused people, people with substance-use disorders or in recovery, immigrants and refugees, and students — groups that advocates worry could fall through the cracks as paperwork requirements multiply. The team includes students with prior outreach experience working with uninsured patients and on HIV- and COVID-related issues, unhoused populations, and street medicine, and the group includes speakers of Spanish and Portuguese.
The planned outreach is intended to help Medicaid recipients navigate the changes.
Abdullah Shihipar, a research associate and narrative projects lead at the People, Place and Health Collective at Brown University, described the fellows’ intended focus on unhoused people, people with substance-use disorders or in recovery, immigrants and refugees, and students.
What Actually Changed on October 1
The upheaval traces back to new federal eligibility restrictions that took effect October 1, which ended Medicaid eligibility for some adults who are not U.S. citizens, according to the Rhode Island Executive Office of Health and Human Services. Fewer than 3,500 noncitizens are expected to be affected, while lawful permanent residents (green card holders) remain eligible after the applicable five-year waiting period. The list of people losing coverage is specific: people granted asylum or refugee status, special immigrant visa holders from Afghanistan, Syria, and Iraq, victims of domestic violence, people with certain special visas, and other formerly eligible visa holders are no longer eligible under the new rules. Rhode Island Medicaid is implementing the changes to comply with federally mandated provisions in H.R. 1, the One Big Beautiful Bill Act, which was signed into law in July 2025.
Some protections remain untouched. Lawfully residing children under 19 stay eligible for Medicaid, and pregnant women remain eligible throughout pregnancy and for 12 months postpartum. Medicaid itself continues to be funded by the federal government and implemented by the states, a structure that has not changed even as eligibility categories shrink.
Work Requirements and More Frequent Renewals Loom in January
The next wave of change lands January 1, 2027, when the Medicaid expansion population becomes subject to new work requirements, per the Globe's reporting. Those requirements will apply to childless adults ages 19 to 64, while adults older than 65 and adults with children are exempt. Affected enrollees must earn more than $580 per month or complete 80 hours of qualifying activities.
On top of the new work rules, Medicaid recipients will need to renew their coverage twice a year instead of once. That added paperwork burden will fall on individuals and the organizations that serve them alike, the Globe notes, which is part of why the Brown fellows' direct-assistance role matters.
The scale of potential fallout is still being debated. The Globe's report cites an estimate of more than 30,000 Rhode Islanders potentially affected.
A Statewide Scramble to Get Outreach Right
Rhode Island's push mirrors a nationwide scramble. Under the 2025 reconciliation law, 44 states must condition Medicaid eligibility for certain adults on meeting work requirements beginning January 1, 2027, according to KFF. States are required to conduct targeted outreach to enrollees and potential applicants. Federal rules also require that work-requirement notices be delivered through at least two separate modalities and spell out who is covered, how to comply, and the consequences of falling short.
Rhode Island's Medicaid system has seen other shifts this fall as well. The state reported 250,294 Rhode Islanders enrolled in Medicaid as of June, plus another 33,569 covered through the related Children's Health Insurance Program, according to Rhode Island Current. As of October 1, the state also stopped covering GLP-1 drugs prescribed for weight loss, though coverage continues for conditions like Type 2 diabetes, and Medicaid will fund Mobile Response and Stabilization Services. Rhode Island's fiscal year 2027 budget separately provides about $116.6 million in additional state and federal funding for Medicaid provider-rate adjustments, per the same outlet.
For now, the Brown fellows represent one of the most concrete local responses to a wave of change that advocates warn could ripple far beyond individual households. With renewals, work-verification paperwork, and eligibility checks all converging at once, the nine students preparing to help Medicaid recipients may be a small team facing an outsized task.
