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Medicaid Changes Could Leave Millions Uninsured
Massachusetts Prepares for Potential Coverage Losses Under New Federal Law
Millions of Americans could lose Medicaid coverage due to new requirements imposed by Congress, sparking concerns among healthcare providers and state officials. Massachusetts is bracing for significant challenges in maintaining coverage for its residents.
Projected Coverage Losses
A recent law is projected to increase the number of uninsured individuals nationwide by 12 to 16 million by 2034. This is due in part to work requirements for enrollees and mandates for more frequent eligibility checks. The Congressional Budget Office (CBO) estimates that five million enrollees could lose coverage because of the work rule, largely due to paperwork issues rather than ineligibility.
Massachusetts Faces Unique Hurdles
In Massachusetts, approximately 200,000 Medicaid recipients and another 100,000 individuals who obtain insurance through the Massachusetts Health Connector could be at risk. Higher premiums, increased paperwork, and more stringent requirements to maintain coverage are all factors contributing to the potential loss of coverage. “It doesn’t make those individuals ineligible for coverage writ large, but it takes away the primary subsidy that makes the coverage affordable,”
said Audrey Gasteier, executive director of the Massachusetts connector.
State Strategies and Concerns
Mike Levine, assistant secretary for MassHealth, the state’s Medicaid administrator, stated, “This is more about, frankly, Congress putting administrative burdens between people and their health care.”
He added, “We have a really good playbook for getting over those hurdles.”
MassHealth intends to conduct extensive background checks to verify eligibility without directly requesting information from enrollees, including reviewing Department of Revenue records. Those who cannot be confirmed will be notified and required to prove their eligibility.
Financial Implications and Healthcare Impact
The new law also scales back the state’s capacity to generate revenue for Medicaid through assessments on healthcare providers. In fiscal year 2025, these assessments generated $2.4 billion. According to the Kaiser Family Foundation, as of January 2024, 40 states impose taxes on hospitals, nursing facilities, or managed care organizations to help finance their share of Medicaid costs (KFF).
The Massachusetts Health & Hospital Association warned that the new law would have “staggering implications”
for health care and could lead to “millions of uninsured people seeking care at underfunded hospitals.”
The association projects a $290 million shortfall in the state’s Health Safety Net fund in fiscal 2026.
Emergency Room Concerns
Dr. Michael VanRooyen, chair of the emergency departments at Mass General Brigham’s 10 hospitals, expressed concern that patients who lose insurance will delay routine care and seek treatment in already overburdened emergency rooms. “We can expect that some people will lose coverage or have lapses in coverage,”
said VanRooyen. “When that happens, emergency departments become the safety net.”
Looking Ahead
Most of the new Medicaid requirements will not take effect until after the 2026 midterm elections, giving Massachusetts some time to prepare. Amy Rosenthal, executive director of the Boston nonprofit Health Care for All, believes that outreach efforts can help many retain their coverage.
