Millions could lose Medicaid coverage due to new rules

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. 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.