To keep coverage, most able-bodied adults between 19 and 64 years old without dependent children will eventually have to document they are either working, in school, or volunteering at least 80 hours a month. <\/p>\n
That provision is intended to weed out people shirking employment. In reality, the vast majority of the millions of able-bodied adults on Medicaid are either working, attending school, or have other limiting conditions, according to the Urban Institute<\/a>, a Washington-based think tank. <\/p>\n The Congressional Budget Office<\/a> projects 5 million enrollees would lose their coverage due to the work rule \u2014 nearly all of them because they will fail to keep up with paperwork requirements and not because they are no longer eligible. <\/p>\n The law also scales back the state\u2019s ability to generate revenue for Medicaid through assessments on health care providers. State officials have not yet calculated the full cost of those limitations but said such assessments generated $2.4 billion in fiscal year 2025.<\/p>\n In Massachusetts, those at risk of losing coverage include about 200,000 people on Medicaid and another 100,000 who buy insurance <\/b>through the Massachusetts Health Connector, the health insurance marketplace set up under the Affordable Care Act. <\/b>The new law raises premiums, increases paperwork, and requires consumers to do more to maintain their coverage, the health policy analysis organization KFF<\/a> reported. The law also makes coverage through the Obamacare marketplaces less accessible to many noncitizen immigrants with legal status. <\/p>\n \u201cIt doesn\u2019t make those individuals ineligible for coverage writ large, but it takes away the primary subsidy that makes the coverage affordable,\u201d said Audrey Gasteier, executive director of the Massachusetts connector.<\/p>\n MassHealth hopes to conduct extensive background checks on many Medicaid enrollees to prove their eligibility without having to <\/b>directly request information, Levine said. That will include reviewing Department of Revenue records to confirm employment or past claims for references to exempting conditions. <\/p>\n Those whom the state cannot confirm on its own will be notified their coverage is at risk and will need to prove their eligibility. But MassHealth\u2019s previous experience with mass mailings suggests many will slip through the cracks. So the agency expects to conduct an outreach effort similar one after the pandemic that could include door-to-door canvassing and partnering with community organizations.<\/p>\n Massachusetts has some time, Levine emphasized. Most of the new Medicaid requirements won\u2019t begin to take effect until after the 2026 midterm elections. <\/p>\n \u201cKeep seeking care,\u201d Levine advised the roughly 2 million MassHealth enrollees. \u201cTake your meds. You don\u2019t need to hoard them. You are not losing coverage tomorrow.\u201d<\/p>\n Amy Rosenthal, executive director of the Boston nonprofit Health Care for All that helped coordinate the previous outreach, said similar efforts could help many keep their coverage. The organization hopes to be involved in the coming effort.<\/p>\n \u201cSome of these red-tape barriers are ones that Massachusetts is uniquely positioned to help people overcome,\u201d said Rosenthal.<\/p>\n New requirements, though, will be costly for states that will have to update software and add staff, Adrianna McIntyre, assistant professor of health policy and politics at Harvard T.H. Chan School of Public Health, said at a Harvard-hosted media briefing Tuesday. <\/p>\n \u201cThere is more opportunity for people to fall through the cracks,\u201d she said. \u201cWhen things can\u2019t be done on an automated basis, you need case workers.\u201d<\/p>\n The state of Georgia implemented a work requirement as part of a Medicaid expansion that cost $92 million, much of it for tech upgrades, according to the Georgia Budget and Policy Institute<\/a>. Meanwhile, just a small percentage of the people eligible for expanded coverage received it, in large part due to the burdensome paperwork requirements. <\/p>\n The Massachusetts Health & Hospital Association said Monday the new law will have \u201cstaggering implications\u201d for health care and would lead to \u201cmillions of uninsured people seeking care at underfunded hospitals.\u201d <\/p>\n The hospital association said the state\u2019s Health Safety Net fund, which helps cover medical care for uninsured patients, will have a shortfall of $290 million in fiscal 2026, $10 million more than the year before. The association is lobbying state officials to funnel more money into the fund, arguing the current number of uninsured and underinsured people in Massachusetts is already straining resources, \u201cnever mind another 300,000 or more people without coverage.\u201d<\/p>\n Dr. Michael VanRooyen, chair of the emergency departments at Mass General Brigham\u2019s 10 hospitals, said he is worried patients who lose insurance will put off routine care until they have health crises. Then they will end up in already crowded emergency rooms.<\/p>\n \u201cWe can expect that some people will lose coverage or have lapses in coverage,\u201d said VanRooyen, who is also a professor of emergency medicine at Harvard Medical School. \u201cWhen that happens, emergency departments become the safety net.\u201d<\/p>\n A high number of patients who end up in emergency rooms don\u2019t speak English, VanRooyen said. Many are already afraid to seek treatment because of the Trump administration\u2019s efforts to deport undocumented immigrants. Some need treatment for mental illness or substance abuse.<\/p>\n Meanwhile, the increased strain will be accompanied by a loss of important revenue MassHealth relies on to support Medicaid: taxes on health care providers. The new law limits taxes on providers to 3.5 percent, far less than what Massachusetts now imposes. <\/p>\n Levine said the state doesn\u2019t have enough information yet to determine how hard Massachusetts will be hit financially. He acknowledged the state will likely be forced to cut access to some services, though it was too soon to say what would be affected. <\/p>\n \u201cThe math is pretty straightforward,\u201d Levine said. \u201cYou need to take a hard look at what we do with the dollars we have available to us.\u201d<\/p>\n Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>. Jonathan Saltzman can be reached at jonathan.saltzman@globe.com<\/a>.<\/p>\n![\"Massachusetts](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/07\/PFCZ3MNCTUXGAALFQHMOSS3Q7Y.jpg\")
Massachusetts Health Connector Executive Director Audrey Morse Gasteier.Leah Willingham\/Associated Press<\/p>\n