80% of Medicaid beneficiaries don’t know about upcoming eligibility changes

Just over 80% of current Medicaid beneficiaries are completely or mostly unaware of the major changes to work requirements and eligibility verification processes, slated to begin in January of 2027, that could determine whether they continue receiving support from their state Medicaid programs. 

According to new data from The Health Management Academy, the vast majority of Medicaid beneficiaries said they had heard “little” or “nothing at all” about the impact of the One Big Beautiful Bill on Medicaid services.   

Major changes in the bill, aimed at states that have taken advantage of Medicaid expansion options in the past, include increasing the frequency of eligibility verification to every six months instead of annually, and implementing a “community engagement” requirement to complete 80 hours per month of work, job training, education, or community service for adults 19-64 without disabilities and/or dependent children.   

Widespread lack of awareness about “community engagement” requirements

Specifically, 55% of Medicaid beneficiaries in the survey said they hadn’t heard that the new “community engagement” requirements, commonly known as work requirements, will be a condition of eligibility starting in January of 2027, and a further 27% said they’d heard some things are changing about work requirements, but aren’t sure of the details. 

Even in Nebraska, where officials have already implemented the work requirements ahead of the federal schedule, just under half (48%) of Medicaid beneficiaries were aware that the conditions of eligibility had changed. 

The downstream risks of rationing care and avoiding services

More than a quarter of Medicaid beneficiaries in the US are likely to be subject to the new rules, creating a multilayered challenge for patients, families, state Medicaid agencies – and the health systems that serve patients on Medicaid. 

At baseline, there will be an anticipated $665 billion in direct revenue losses from Medicaid cuts to health systems over the next ten years as federal funds decrease and approximately 8 million current beneficiaries lose coverage due to the changing criteria. 

The long-term health impacts (and commensurate increases in spending on potentially uncompensated care) have yet to be fully quantified, but they are likely to be significant as the first response to losing insurance coverage is often to avoid care. 

Those who become ineligible for Medicaid coverage are likely to do exactly that, the Health Management Academy survey said.  About 60% of respondents said they will stop going to the doctor unless or until they experience an emergency.  Just over 4 in 10 would ration or stretch their existing medication, stop filling at least one prescription, or skip specialist appointments, while a quarter would delay planned procedures or surgeries due to cost.     

People with chronic diseases – about 75% of the overall Medicaid population – are even more likely to struggle with managing their care if they cannot access Medicaid services.  Among people who identified as having a chronic condition, 6 in 10 would ration medication or stop filling a prescription, and 55% said they would stop seeing their specialists.   

Concerningly, about a quarter of those who take medications said their mental health prescriptions would be the first to go.  Blood pressure and cholesterol medications were second (22%), and diabetes medications (17%) followed close behind. 

These figures should be ringing warning bells for health systems that already spend an enormous amount of time and resources helping patients manage their chronic conditions, with varying levels of success among high-risk populations.  Without access to ongoing care or basic maintenance medications, that challenge is poised to increase dramatically. 

Supporting Medicaid beneficiaries in a time of change

The eligibility and funding cuts themselves pose major problems for health systems and high-needs populations, but the greater risks, at least immediately, might be the lack of awareness surrounding the changes. 

State governments are planning to launch broader awareness campaigns starting this summer, the Health Management Academy says, but health systems themselves may need to take a larger role in preparing their Medicaid populations for twice-yearly verifications and work requirement documentation. 

Investing now in additional resources to provide outreach and assistance to Medicaid beneficiaries could reap benefits down the line, as every Medicaid dollar takes on heightened importance. 

Proactively helping beneficiaries learn about the changes and what they mean for themselves and their families could become an important strategy for avoiding disruptions to care while preserving as much revenue stability as possible in a very challenging economic climate. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].