10M could lose Medicaid due to work requirements, more frequent eligibility checks, study finds
Summary
An Urban Institute and Robert Wood Johnson Foundation analysis projects that between 5 million and 10 million people could lose Medicaid by 2028 because of new work requirements and more frequent eligibility checks introduced in last year’s reconciliation law (the “Big Beautiful Bill”). The study estimates 2.0–3.1 million losses from switching redeterminations to every six months, and 3.0–7.0 million losses tied to work‑reporting mandates. Even people who already meet work rules could be disenrolled because of documentation and verification problems.
The researchers modelled three state mitigation scenarios — low, medium and high — based on how actively states use data matching, define exemptions (such as medical frailty) and reduce paperwork burdens. Under those scenarios, projected average monthly expansion enrolment in 2028 would be 8.3 million (low mitigation), 10.5 million (medium) and 13.5 million (high), compared with 18.4 million if the policy changes had not occurred.
Key Points
- Overall projected losses in 2028: between 5 million and 10 million Medicaid enrollees, depending on state mitigation efforts.
- Six‑monthly eligibility checks could cause 2.0–3.1 million people to lose coverage.
- Work requirements could result in 3.0–7.0 million losing Medicaid; many losses stem from documentation failures, not lack of work.
- Between 19% and 37% of people who already work could be disenrolled because they cannot document compliance.
- Certain groups face higher risk: 30%–73% of self‑employed enrollees and 19%–52% of those living with a family member with a disability could be disproportionately affected.
- State flexibility matters: stronger automatic data matching and broader exemption definitions substantially reduce projected coverage losses.
Context and relevance
This analysis comes as states begin implementing major Medicaid changes in the reconciliation law signed last year. The findings matter for policymakers, employers, HR teams and benefits administrators because large coverage losses can shift costs to hospitals and employers, increase uncompensated care, and affect workforce health and productivity. The study highlights how administrative design — automatic verification, exemption rules and documentation requirements — will determine whether people lose coverage for good or stay enrolled.
Author’s take
Punchy summary: this isn’t a small tweak — it’s a systemic shock if states don’t invest in verification and outreach. If you work in benefits or public policy, drill into the mitigation scenarios. The numbers are big, and the losers are often the hardest‑to‑reach people: self‑employed workers, caregivers and those struggling with paperwork.
Why should I read this?
Because it spells out who might suddenly lose health cover and why — and gives a clear reminder that implementation choices (not just the law itself) will decide how many people fall through the cracks. If you manage staff benefits, advise vulnerable clients, or work in policy, this saves you time: read the headlines here and decide whether you need to act now.