What's Happening?
A recent analysis by the Urban Institute and the Robert Wood Johnson Foundation forecasts that between 5 million and 10 million individuals could lose Medicaid coverage by 2028. This potential loss is attributed to new work requirements and more frequent
eligibility checks introduced by last year's reconciliation law, known as the 'Big Beautiful Bill.' The study estimates that 2.0 to 3.1 million people could lose coverage due to the switch to six-monthly eligibility checks, while 3.0 to 7.0 million could be affected by work-reporting mandates. Even those who comply with work rules might face disenrollment due to documentation and verification issues. The researchers explored three state mitigation scenarios—low, medium, and high—based on states' use of data matching, exemption definitions, and paperwork reduction. These scenarios project varying levels of Medicaid enrollment in 2028, ranging from 8.3 million to 13.5 million, compared to 18.4 million if the policy changes had not been implemented.
Why It's Important?
The findings of this study are significant for policymakers, employers, and benefits administrators as they highlight the potential for substantial coverage losses. Such losses could shift healthcare costs to hospitals and employers, increase uncompensated care, and impact workforce health and productivity. The study underscores the importance of administrative design, including automatic verification and exemption rules, in determining whether individuals lose coverage permanently or remain enrolled. The potential disenrollment of individuals who already meet work requirements, due to documentation issues, poses a risk to vulnerable groups, including self-employed workers and those living with family members with disabilities.
What's Next?
As states begin implementing these Medicaid changes, the focus will likely be on how effectively they can mitigate potential coverage losses. States may need to invest in verification systems and outreach efforts to ensure that eligible individuals remain covered. The study suggests that stronger automatic data matching and broader exemption definitions could significantly reduce projected coverage losses. Policymakers and stakeholders in the healthcare sector will need to monitor the impact of these changes closely and consider adjustments to minimize negative outcomes.
