Due to confusion surrounding how to verify that they are working, millions of eligible enrollees in Medicaid could lose their coverage by 2027. The One Big Beautiful Bill Act, passed in July 2025, made headlines when it introduced these work requirements as part of its cuts to Medicaid, sparking concern that there could be major consequences regarding both individuals losing coverage and hospitals in rural and low-income areas that rely on Medicaid funding to survive…
Joel Cantor, ScD, professor of public policy and the founding director of the Center for State Health Policy at Rutgers University, explained further, “The bottom line is that it requires specific documentation of community engagement. Primarily work, but it could be childcare, it could be caregiving for a disabled child or parent, it could be volunteering, it could be education.”
Cantor also acknowledged that, for people who work independently or for smaller companies without a human resources department, this could create a huge paperwork barrier for people who are working but do not understand the process of applying, which is the major concern when looking at decreases in Medicaid enrollment.
According to the Congressional Budget Office,2 this would likely cause a loss of 5.2 million adults on Medicaid by 2034 and would result in $324 billion in cuts in the same time period. Oberlander noted that these requirements only apply to Medicaid expansion states. All but 10 US states have expanded Medicaid coverage,3 which effectively makes this change nearly universal across the country. Implementing these changes could introduce a new host of problems…
Cantor also pointed out the timing of when these changes will be implemented, after the midterm elections in 2026. “Now we’re experiencing public reaction to the expiration of the extra subsidies for [the Affordable Care Act]. These are even lower-income people than that, but [the effect] won’t be felt until after the election next year,” he said.
He also pointed out that state Medicaid agencies are feeling more stress than before, as offices are already low on resources for their current work without adding more paperwork each year, and more reach out to those who need to prove their employment.