Millions of Americans could face hurdles in keeping their Medicaid coverage next year, and a new survey found nearly half of program recipients are unprepared to navigate the changes.
Starting January 1, certain adults will have to demonstrate at least 80 hours per month of work, education, community service or other qualifying activities to enroll in or maintain their Medicaid coverage.
With the changes pending, a new survey commissioned by Aeroflow Health found that while 63 percent of respondents said they were aware of the coming requirements, 44 percent said they were not prepared to submit the documentation needed to comply.
Why It Matters
Medicaid provides health coverage to lower-income Americans and is financed by both the federal government and states. The new requirements mark a major change to eligibility for many working-age adults previously covered by the program.
Under rules of the Centers for Medicare & Medicaid Services (CMS), the requirement generally applies to non-pregnant adults ages 19 through 64 who are not enrolled in Medicare and who receive coverage through the Medicaid expansion population or certain Section 1115 demonstration programs.
Those affected by the change can satisfy the new requirement through at least 80 hours per month of qualifying activities, which can include employment, work programs or community service. Enrollment in an educational program at least half time can also qualify, and the activities can be combined.
However, experts say, the stakes go beyond whether beneficiaries actually work enough hours.
"One of the biggest concerns with Medicaid revisions was additional requirements that most beneficiaries would fail to realize only after their implementation," Alex Beene, financial literacy instructor for the University of Tennessee at Martin, told Newsweek.
The Aeroflow Health findings suggest that some people who are eligible for coverage could still struggle with the administrative process needed to prove it.
"People should not lose Medicaid coverage because the reporting process was confusing, especially when they have met the requirements or qualify for an exemption," Casey Hite, CEO of Aeroflow Health, said in a statement. "That is the risk our findings expose. Awareness is not readiness."
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Nearly Half Say They Aren't Ready
Although nearly two-thirds of the Medicaid members surveyed knew the requirements were approaching, being ready for them was a different matter. Roughly 44 percent said they were not ready to submit the required documentation, and 46 percent said they had received no reminders about the coming mandates. Another 42 percent said they received between one and three reminders. One-third said their biggest concern was figuring out whether they qualified under the new rules.
"This new rule covers ages 19-64 and while there will be exceptions, for the majority of beneficiaries, this is the new normal," Beene said. "Preparing for this change and additional paperwork involved is key."
The consequences of a coverage disruption could be severe. The survey found 53 percent said they had already delayed or altered healthcare due to concerns about coverage, while 89 percent said losing Medicaid would affect their ability to obtain care or medical supplies.
Who Will Have to Meet the New Medicaid Requirements?
Not every person receiving Medicaid will be subject to the new policy.
CMS has said the requirement generally applies to non-pregnant adults ages 19 to 64 who are not entitled to or enrolled in Medicare and are in the Medicaid adult expansion group or demonstration programs.
People subject to the rule can comply as long as they prove 80 hours a month of qualifying activities, whether through employment, work programs, community service or through half time or more enrollment in an educational program.
“The priority is reporting and making sure you hold those who are requesting benefits remain accountable,” Kevin Thompson, CEO of 9i Capital Group and host of the 9innings podcast, told Newsweek. “The concern for the administration is to root out what they deem waste and abuse of the system, although very little has been discovered.”
Recipients exempt to the new rule include those pregnant and postpartum, people who are disabled or medically frail, parents and caregivers of children under age 14 or people with disabilities, and American Indians and Alaska Natives, depending on their circumstances.
How Many People Could Lose Medicaid?
CMS has previously said that around 2.3 million people could lose Medicaid coverage in 2027 and roughly 3.2 million annually thereafter. This projection assumes some people will lose coverage for failing to satisfy the requirements and others will lose it because of paperwork or other administrative barriers.
But other estimates are considerably higher.
Manatt Health predicted average annual Medicaid coverage losses of about 8.2 million people from federal fiscal years 2027 through 2034.
Concerns Over Paperwork and Coverage Loss
While state Medicaid agencies are working to update information technology systems and staffing ahead of the January rollout, navigating eligibility systems and the administrative hurdles can still be challenging for many.
CMS said itself in a website post that “implementation of the new community engagement requirements necessitates major system, policy, and operational changes to state programs in the coming years.”
Thompson said the new work requirements will pose issues, mainly due to the enhanced documentation and filing: “You will now be required to report every six months with mandatory tracking of 80 hours per month.”
What Happens Next
The new requirements will go into effect on January 1.
"The worst scenario would be losing benefits over a simple misunderstanding of how to report the hours for the new requirement and what qualifies," Beene said.
Newsweek’s reporters and editors used Martyn, our AI assistant, to produce this story. Learn more about Martyn here. Contact Newsweek editors on this story: Jason Lemon and Edward T. Cummins