Millions could lose Medicaid coverage as new reporting rules take effect

Millions at risk of losing Medicaid coverage

New federal work-reporting requirements and more frequent eligibility reviews are projected to reduce Medicaid enrollment by millions of people over the next several years.

Researchers warn that administrative problems could cause some eligible enrollees to lose coverage because they fail to document qualifying activities or exemptions. Others may lose eligibility because they do not meet the new requirements.

What the new work rule requires

Under the federal Medicaid community-engagement requirement, certain adults ages 19 to 64 must generally complete at least 80 hours per month of employment, community service, education, or another qualifying activity, or satisfy an earnings-based standard.

The rule primarily applies to adults enrolled in Medicaid under the Affordable Care Act’s Medicaid expansion. States must comply with the federal requirements by January 1, 2027, although some states have begun implementation earlier.

Estimates put coverage losses in millions

Congressional Budget Office estimates associated with the federal legislation indicate that Medicaid work requirements could leave approximately 5 million more people uninsured by 2034 and reduce federal Medicaid spending by hundreds of billions of dollars.

The Urban Institute projects that work requirements and twice-yearly eligibility reviews together could reduce Medicaid expansion enrollment by 4.9-10.1 million people per month on average in 2028, depending on how effectively states limit procedural coverage losses.

Eligibility checks are moving twice a year

States will generally be required to conduct eligibility redeterminations every 6 months for adults covered through the Medicaid expansion population, rather than limiting reviews to once a year.

Researchers estimate that these more frequent checks alone could cause between 2 and 3.1 million people to lose coverage, independent of the work requirement’s impact.

Some states are already rolling it out

Nebraska began enforcing Medicaid work requirements on May 1, 2026. Montana implemented its requirements on July 1, while Arkansas began a soft launch on the same date but does not plan to impose coverage penalties for noncompliance until January 2027.

Medicaid is jointly financed by the federal and state governments. Federal data recorded approximately 67.1 million people enrolled in Medicaid in March 2026, excluding separate CHIP enrollment.

Little-known fact: Medicaid is a joint federal-state program providing healthcare coverage to 73 million Americans, roughly 20% of the U.S. population.

What Arkansas revealed about Medicaid paperwork

Arkansas implemented a Medicaid work requirement under a federal waiver in 2018. A federal judge halted the program in March 2019 after finding that its approval had not adequately considered Medicaid’s central purpose of providing health coverage.

More than 18,000 adults lost coverage before the requirement was halted. Research found no significant increase in employment and concluded that confusion, reporting difficulties and limited awareness contributed substantially to the coverage losses.

Certain workers face bigger hurdles

Experts say people in hourly jobs without consistent documentation of their work hours face the highest risk, along with those who lack reliable internet access at home.

Fluctuating work schedules and jobs without a formal human resources department can also make it harder for eligible workers to prove they meet the requirements on time.

Exemptions exist but details vary widely

People who are pregnant, medically frail, or otherwise excluded under federal rules are not subject to the Medicaid community-engagement requirement. Exemptions also cover certain parents and caregivers, including people responsible for a dependent child age 13 or younger or a person with a disability.

States are expected to use available data to identify exemptions when possible, but some enrollees may still need to provide information to demonstrate their eligibility.

Little-known fact: Medicaid covers roughly 50% of children’s hospital patients and 35% of pediatricians’ caseloads, the highest share of any medical specialty, according to the American Medical Association.

One woman’s coverage vanished after childbirth

A 36-year-old supermarket cashier in Atlanta had been meeting the work requirement for months, but her Medicaid and food stamps were abruptly turned off after she gave birth.

Advocacy groups point to cases like hers as evidence that administrative errors, not actual ineligibility, are already causing real coverage losses even before enforcement fully begins nationwide.

Supporters say the rule targets real gaps

Backers of the law argue the work requirement encourages self-sufficiency and is projected to reduce federal Medicaid spending by roughly $324 billion over the next decade.

They say the changes bring accountability to a program that had grown significantly since Medicaid expansion, and that most enrollees already meet the requirement through existing jobs.

Critics call the rule an unnecessary barrier

Human rights researchers argue the requirement addresses a problem that largely doesn’t exist, since most Medicaid recipients already work in some capacity or qualify for an exemption.

Critics say the policy won’t meaningfully fix state or federal budgets and will instead strip coverage from working people who simply struggle to prove their hours on time.

Most nationwide effects will emerge in 2027

States generally must implement the federal Medicaid community-engagement requirement by January 1, 2027, although several states began earlier. As a result, the broad nationwide effect on enrollment is expected to become clearer during 2027 and later years.

State Medicaid agencies will have to verify work activities, identify exemptions, conduct more frequent eligibility reviews, and notify enrollees about the new requirements. The administrative workload will depend partly on how effectively each state uses existing government data to automate those processes.

Want to read more about the latest Medicaid policy changes? Check out how New Jersey enacts Medicaid-linked employer fee as other states consider similar measures.

What enrollees can do to protect coverage

Health experts recommend documenting work hours consistently, saving pay stubs or schedules, and submitting any exemption paperwork early rather than waiting until a renewal deadline finally approaches.

If coverage is lost, people can reapply once they’re back in compliance, but any medical costs incurred during that gap become the individual’s own full financial responsibility.

Curious how Medicaid policy changes are affecting care across the country? Check out how Illinois sees its home care crisis deepen due to Medicaid changes.

What do you think about Medicaid work requirement rules? Share your thoughts in the comments, and leave a like if staying informed about coverage requirements matters.

This slideshow was made with AI assistance and human editing.

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