Medicaid Coverage Changes: Forecasts and Impacts of Federal Policy

A recent study by the Urban Institute, backed by the Robert Wood Johnson Foundation, reveals substantial shifts in Medicaid coverage across 41 states that extended eligibility under the Affordable Care Act. Changes in federal policy concerning work requirements and more frequent eligibility checks are expected to impact Medicaid coverage significantly in these states.

The report forecasts that by 2028, between 4.9 to 10.1 million individuals may lose Medicaid coverage because of these policy changes. This forecast aligns with the Congressional Budget Office's estimation of an additional 7.5 million uninsured individuals by 2034. State-specific policies, such as the adoption of automatic eligibility checks and broader exemption definitions, will considerably influence the actual impact on Medicaid coverage losses.

Conversely, states with stricter documentation of work hours and limited exemptions could witness substantial enrollment declines. States like Connecticut, Massachusetts, and New York might see coverage decreases exceeding 60%, while Arkansas, Idaho, and New Mexico could encounter reductions varying from 37% to 46%. Even in states with more lenient policies like North Dakota, projected declines range from 18% to over 30% in certain states.

Impact on Employed Medicaid Recipients

The analysis also highlights that 19% to 37% of currently employed Medicaid recipients could lose their coverage due to challenges in meeting documentation requirements. States must begin to enforce work requirements by January next year, with some potentially starting sooner through waivers or state plan amendments. For instance, Nebraska plans to implement these requirements in May.

Despite these stringent measures, specific groups, including American Indian, Alaska Natives, and "medically frail" individuals, among others, will be exempt from the work requirements. This includes caretakers of young children or people with disabilities and foster or former foster youth under 26, reflecting the complex landscape of regulatory compliance in Medicaid policy shifts.