New Federal Medicaid Work Rules May Cut Rolls by Up to 10 Million

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A new report projects that between 4.9 million and 10.1 million people will lose Medicaid coverage by 2028 due to new federal work requirements and more frequent eligibility checks. The actual number will depend on how states implement the new rules, with stricter state policies resulting in larger enrollment declines.

Why it matters

The Affordable Care Act's Medicaid expansion provided health coverage to millions, and these federal changes could significantly reduce access to care, especially in states that take a more stringent approach to the new work requirements.

The details

The report by the Urban Institute found that states that automatically check eligibility using data-matching, impose the minimum work requirements, and broadly define exemptions will see smaller coverage losses. In contrast, states that require stricter documentation of work hours and implement narrower exemptions will see more people dropped from the rolls. Nationwide, between 19% and 37% of people who already work are projected to lose Medicaid coverage due to challenges meeting the new documentation requirements.

• The new federal work requirements must be enforced by January 2024.
• Nebraska plans to implement the requirements earlier, in May 2023.

What’s next

States have until January 2024 to enforce the new Medicaid work requirements, but some may implement them earlier through waivers or state plan amendments.