Millions Could Lose Medicaid Coverage Due to New Rules

The Issue

H.R. 1, or the One Big Beautiful Bill Act, created new work requirements for Medicaid expansion coverage and requires that states check whether expansion enrollees are still eligible for Medicaid every six months. The extent of coverage losses will depend on state policy and implementation choices. In this report, researchers modeled enrollment impacts under high, medium, and low mitigation scenarios that consider how actively states work to minimize the number of people losing coverage. 
 

Key Findings

• Between 4.9 and 10.1 million people will lose Medicaid coverage in 2028 due to work requirements and more frequent eligibility checks under high and low mitigation scenarios, respectively. 
  • Between 2 and 3.1 million will lose coverage due to their eligibility being redetermined more frequently.
  • Between 3 and 7 million people will lose Medicaid coverage due to work requirements alone, after accounting for the impact of more frequent eligibility checks. 
• Researchers project enrollment will decline in each state that expanded Medicaid eligibility, with the extent of the decline depending on steps states take to limit coverage losses, as well as on the composition of expansion enrollees in their state.
• Researchers find that between 19% and 37% of people who already work will nevertheless lose Medicaid coverage, including some who are meeting the work requirement but would face challenges documenting their work activity.
• Many others are projected to lose coverage despite meeting criteria that could make them exempt from or compliant with work requirements, such as being a student, being a family caregiver, or having a disability.

Conclusion

Researchers say that state policy decisions related to the implementation of these provisions will lead to big differences in coverage changes across states. Many people who are working or who could qualify for an exemption from work requirements are at risk of losing coverage. People who are self-employed, work irregular schedules, are students, are caring for disabled family members, or are 50 or older are at particularly high risk.

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Division for more information specific to its staff and its recent research.