Prepare for Medicaid Verifications with Trusted Education Data

How the Clearinghouse Can Help You Streamline the Process

Medicaid eligibility is undergoing a major transformation. The 2025 reconciliation law — officially H.R. 1 / Public Law 119-21 and widely referred to as the “One Big Beautiful Bill Act” — marks one of the most significant changes to Medicaid eligibility in recent years. For certain adults aged 19-64, eligibility will soon hinge on meeting community engagement requirements, which can be met by showing engagement through work, volunteering, job training, or participation in an eligible educational program.

This shift is a compliance challenge that will impact states, managed care organizations, and local education agencies nationwide. With implementation expected on January 1, 2027, the clock is ticking for states to prepare.

Why Does Reliable Education Data Matter?

The law introduces several key requirements that will reshape Medicaid eligibility processes. In relation to education, this includes half-time enrollment. While further guidance is coming on the meaning of “half-time,” preliminary analyses suggest alignment with existing higher education standards.

States should anticipate more frequent eligibility checks ─ as often as every six months ─ along with earlier outreach and notice requirements to minimize coverage loss. This means that eligibility systems must be ready for continuous verification cycles.

In turn, one of the challenges that states are facing is audit readiness. States need accurate education data, such as enrollment status and certification dates, to support notices, appeals, and fairness in determination.

For instance, states may need to confirm whether an individual is enrolled at least half-time to determine if they meet the requirement. Without accurate data, administrative costs rise because of manual paperwork and appeals, or audit risks increase, jeopardizing program integrity.

Overall, this makes reliable education verification a necessity.

How Can the National Student Clearinghouse Support Medicaid Compliance?

The National Student Clearinghouse can help state agencies, and educational organizations meet the new Medicaid requirements by providing education data.

As a trusted entity nationwide by educational organizations, employers, and agencies, our secure data exchange supports audit-ready reporting and supports program integrity. In turn, coverage is vast, including nearly 3,600 institutions in the United States reflecting 97% of the national postsecondary enrollment. This includes all students reported by participating institutions, not just loan borrowers.

There are two delivery options for the education data:

1. Insights API: Real-time education status verification for eligibility systems and portals.
2. Secure Batch: High-volume file processing (daily or weekly) for cohorts at application or renewal.

Next Step

Prepare for Medicaid verification by using trusted education data from the Clearinghouse. Fill out our form online or email us at business@studentclearinghouse.org to request a consult.