Hospitals are reportedly panicking over new Medicaid work requirements in January after President Trump slashed $1 trillion in funding for the program in 2025 — and some lawmakers on Capitol Hill are pushing for a two-year delay of the reforms.
At risk is coverage for nearly 19 million patients on Medicaid between the ages of 19 and 64 who are able-bodied and without young children. Under new rules slated to take effect on Jan. 1, they will be required to provide proof of 80 hours of work a month, including volunteering and schooling.
The Congressional Budget Office estimates the work requirements will save the government $326 billion over the next 10 years. At the same time, the CBO forecasts that the number of insured will increase by 5.3 million over the next seven years because of the new rules.
State Medicaid offices will be bearing much of the logistical burden. The Center on Budget and Policy Priorities issued a report this spring claiming that the states do not have enough time to implement the process and do not have enough guidance from the feds.
“Most don’t have capacity to handle the work requirement and other onerous changes,” the report said.
Community groups are calling patients, and one hospital in Indiana has been dispatching teams to low-income neighborhoods, according to The New York Times, all in an effort to avoid a drop in Medicaid reimbursements for hospitals and for patients seeking care.
The process to determine eligibility will vary state-by-state but it will require enrollees to submit pay stubs or some form of hours documentation. Other states may have data-matching systems where people can be automatically renewed more easily.
Freelancers, part-time employees, seasonal farm laborers and gig workers may have a more difficult time proving eligibility, according to the paper. Ad-hoc lump sum payments and inconsistent work may make the new red tape harder to cut through.
After the recent election, a coalition of Senate Democrats are calling for the implementation of the work requirements to be pushed back by two years.
New York is expecting 475,000 patients to lose health care, according to the state attorney general’s office. Local public hospitals in New York are increasing staffing and increasing outreach, according to a local news outlet, the City Reporter.
“This will be a crisis,” said Dr. Ted Long, a senior vice president and chief medical officer for clinical services and population health at Health + Hospitals, at a recent city council hearing. “We’re going to move heaven and earth to do as much preparation as we can.”
A safety-net hospital executive in Indiana told the New York Times that they are sending out teams into low-income areas in Indianapolis to prepare patients. “There’s going to be people who fall through the cracks,” said Nicole Harper, chief financial officer at Eskenazi Health. “We’re bracing for impact.”
In Louisiana where more than 40% of the population is covered by Medicaid, a health advocacy group, CARE Louisiana, has been sounding the alarm bell about the changes.
“Medicaid is a cornerstone of Louisiana’s health care system, providing coverage to more than 1.3 million residents,” said CARE Louisiana Chair SarahJane Guidry in a statement in August. “While most adults enrolled through Medicaid expansion are already working, this rule risks taking health care away from eligible people due to reporting challenges and system limitations.”
Both of the state’s senators have supported the changes. Sen. John Kennedy sees them as a way to reform a broken system. “Medicaid used to be for the poor and elderly. Now in some states Medicaid will pay for your house or hire you a chef,” Kennedy said.
The US Centers for Medicare & Medicaid Services did not immediately respond to a request for comment.
