Millions May Lose Medicaid Under Trump Budget Law

New work requirements and eligibility reviews could strip coverage from millions, including disabled and chronically ill patients

Apr. 16, 2026 at 8:58pm

Got story updates? Submit your updates here. ›

A ghostly, glowing X-ray image revealing the intricate internal structures of a human heart and lungs, conceptually representing the fragility of healthcare access for chronically ill Medicaid recipients.An X-ray view into the delicate internal structures that Medicaid helps sustain for millions of vulnerable Americans.Green Bay Today

A new report from the Urban Institute projects that millions of Americans who depend on Medicaid may soon lose their benefits due to changes to eligibility requirements included in President Donald Trump's most recent budget law. The law mandates that states conduct twice-yearly eligibility reviews and imposes new work requirements for Medicaid recipients, which could lead to a loss in coverage for between 4.9 and 10.1 million people nationwide by 2028.

Why it matters

The loss of Medicaid coverage could have devastating consequences for vulnerable populations, including the disabled, chronically ill, and elderly who rely on the program for essential healthcare. Patients like Barbara Lockington, who has a genetic liver disease and requires a transplant and ongoing treatment, fear they will be unable to afford necessary medical care if they lose their Medicaid benefits.

The details

The new requirements in the Trump budget law, known as the One Big Beautiful Bill Act, mandate that states conduct twice-yearly eligibility reviews for Medicaid and impose work requirements for recipients. According to modeling by the Urban Institute, this could lead to a loss of coverage for between 4.9 and 10.1 million people nationwide by 2028. In Wisconsin, an estimated 63,000 residents could be at risk of losing Medicaid under the new rules.

  • The One Big Beautiful Bill Act was signed into law by President Trump in July 2025.
  • The new Medicaid work requirements are set to take effect on January 1, 2027.
  • The Urban Institute's projections estimate the coverage losses could occur by 2028.

The players

Barbara Lockington

A 50-year-old Medicaid recipient from Holmen, Wisconsin, who has a genetic liver disease and received a liver transplant five years ago. She relies on Medicaid to cover her ongoing medical treatment and medications.

Christine Hyde

A nurse practitioner at a Planned Parenthood clinic in Green Bay, Wisconsin, who treats many patients who rely on Medicaid for their healthcare coverage.

Urban Institute

A nonpartisan research organization that produced a report projecting the potential coverage losses from the Medicaid changes in the Trump budget law.

Got photos? Submit your photos here. ›

What they’re saying

“As far as the work requirements, I physically cannot make those work requirements. I just can't. I wish I could get people to understand that pain in and of itself is extremely debilitating.”

— Barbara Lockington, Medicaid Recipient

“Most of the patients that are on Medicaid are working, and if the work requirements change, and so, say they have to work more hours, then they'll likely fall off of Medicaid, and then if they can't afford their employer's insurance, a lot choose to go uninsured, which is a scary thought, as a clinician, to think about people having potentially preventative care situations that are going untreated and undiagnosed.”

— Christine Hyde, Nurse Practitioner

“Congratulations that you have now signed the death warrant of how many thousands of American citizens — literally, their death warrants, because without that, people are not going to be able to afford to go to the doctor. They're not going to be able to afford their medicines to stay alive.”

— Barbara Lockington, Medicaid Recipient

What’s next

The new Medicaid work requirements are set to take effect on January 1, 2027, and states must establish systems to comply with the new reporting requirements. The impact of these changes will continue to be monitored and debated in the coming years.

The takeaway

The Medicaid coverage losses projected under the Trump budget law could have severe consequences for vulnerable populations who rely on the program for essential healthcare. This highlights the ongoing debate around the role of work requirements and eligibility reviews in social safety net programs, and the need to balance fiscal responsibility with ensuring access to care for those most in need.