News ACA Open Enrollment Opens November 1 Amid Medicaid Work Requirement Changes

In its October 23, 2026 weekly newsletter, the National Disability Navigator Resource Collaborative (NDNRC), supported by the American Association on Health and Disability (AAHD), highlighted resources for the coming Open Enrollment period. Author Michelle Sayles notes that this enrollment year carries added weight as people work through new Medicaid work requirements alongside Marketplace options.

The cost argument

The newsletter makes the case that coverage decisions matter more for people with disabilities because the underlying cost burden is higher. It states that “people with disabilities have an even higher annual cost of living than non-disabled individuals,” citing a recent study placing the difference at $5,341 in additional annual expenses, with health-related costs a substantial share.

That framing points to why plan selection is not a formality. Rehabilitation services, mental health care, and high-cost durable medical equipment such as prosthetics and wheelchairs fall under the Affordable Care Act’s essential health benefits. The newsletter also flags understanding access to Home and Community-Based Services (HCBS) as a key piece of the picture.

Resources for assisters

NDNRC’s Guide to Disability for Health Insurance Marketplace Navigators covers disability definitions, historical barriers to coverage, disability rights laws, the disability questions on the streamlined application, disability literacy and etiquette, physical accessibility, effective communication, evaluating provider networks and essential health benefits, Medicaid eligibility, and common accommodations.

The newsletter also points to CMS training, Working with Individuals with Disabilities, and to its own October 9 newsletter covering what is new this coverage year.

What this means for your practice

Most of us are not Navigators, and that is the point. The people we work with will encounter Open Enrollment whether or not anyone helps them through it, and the ones most likely to let the window close are the ones who most need what is on the other side of it.

Where to focus:

• Put the dates on the calendar now. The window is November 1 through January 15. For coverage effective January 1, enrollment generally needs to be complete by mid-December, so treat December as the working due date rather than January.
• Know who is newly in the Marketplace this year. People losing Medicaid coverage, including through work requirement changes, may be eligible for Marketplace coverage, and loss of Medicaid typically opens a special enrollment period. Someone who learns in February that their coverage ended in January still has options. Make sure they know that.
• Pursue exemptions before pursuing a plan. For many people with behavioral health conditions and disabilities, the right outcome is not a Marketplace plan but a documented exemption from the work requirement that keeps Medicaid in place. Exemption documentation draws on the same functional evidence that supports a disability application, so the work overlaps with what your team already does.
• Evaluate plans on the specifics that matter. Behavioral health network adequacy, prescription formularies, durable medical equipment coverage, and rehabilitation limits determine whether a plan actually works for someone. The lowest premium frequently is not the lowest annual cost.
• Find your local Navigator and build the relationship. Then hand off warmly rather than referring and hoping. NDNRC’s guide is worth reading even if you never enroll anyone, because it tells you what a good enrollment conversation looks like.
• Connect coverage to the income conversation. Someone applying for disability benefits, someone newly working, and someone facing a work requirement are all making coverage decisions at the same moment. Those decisions should be made together, not in three separate appointments.

Income alone does not close the gap when the cost of living is structurally higher. Coverage is one of the threads that has to be woven in alongside it.

Sources: National Disability Navigator Resource Collaborative newsletter, October 23, 2026