The task is not as simple as pushing through a software update on your smartphone or personal computer. That\u2019s because each state has its own system for managing Medicaid, often requiring experts to make customized changes.<\/p>\n
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\u201cOur current eligibility systems are pretty old, and the ability to change them is very, very difficult,\u201d said Toi Wilde, chief information officer for the Missouri Department of Social Services.<\/p>\n
New Medicaid requirements affect millions, but not all<\/p>\n
The big tax-cut law<\/a> signed last year by Trump is financed, in part, by sweeping Medicaid changes intended to cut government spending. Two of the most prominent will apply in four-fifths of the states, affecting Medicaid enrollees ages 19 through 64, without young children, whose incomes are above the typical eligibility cutoff.<\/p>\n Those Medicaid participants will have to work or do community service at least 80 hours a month, or enroll at least half-time as a student. They also will face eligibility reviews every six months, instead of annually, meaning they could lose coverage more quickly when their circumstances change.<\/p>\n The two provisions together are projected to save the federal government $388 billion over the next decade, resulting in 6 million fewer people with health insurance, according to the Congressional Budget Office.<\/p>\n But states first must update their online portals used by Medicaid participants, their aging computer systems used by state workers and their methods of verifying information through various databases.<\/p>\n Most will have to turn to private contractors to meet the time crunch. At least 10 companies have agreed to offer discounted services, according to the federal Centers for Medicare and Medicaid Services.<\/p>\n Making those technology upgrades \u201cis going to be a lift. It\u2019s not something straightforward. It\u2019s not easy,\u201d said Jason Reilly, a partner at Guidehouse, a firm that is advising several states on the Medicaid requirements.<\/p>\n Most states don\u2019t currently collect employment or education information about Medicaid participants. So states are looking to tap into outside sources to verify job and school data. But there\u2019s no database of community volunteers.<\/p>\n And states are still waiting on federal rules \u2014 not due until June \u2014 to define some of the exceptions to the work requirements, such as how to determine who qualifies as \u201cmedically frail.\u201d<\/p>\n States face extra pressure to get it right because the federal government will start penalizing states with too many Medicaid payment errors in October 2029.<\/p>\n Congress guaranteed all states a share of the $200 million allotted for Medicaid work and eligibility changes. But states must apply for additional federal money. The federal government covers up to 90% of states\u2019 costs to develop systems for determining Medicaid eligibility, 75% of costs to maintain those systems and half of most other administrative costs.<\/p>\n Missouri won early approval for the 90% federal funding rate. State lawmakers now are fast-tracking a $32 million appropriation needed to solicit bids for vendors to start upgrading technology platforms and improving a chatbot for Medicaid participants. Over the next year, the state\u2019s social services agency expects to need about 120 additional workers \u2014 at a cost of $12.5 million \u2014 to handle the extra administrative workload.<\/p>\n Other states also project large costs. Maryland expects to spend over $32 million in federal and state funds to implement the Medicaid changes, Kentucky more than $46 million and Colorado over $51 million. Arizona estimates it could cost $65 million \u2014 and require 150 additional staff \u2014 to implement the new federal requirements.<\/p>\n Some states surveyed by the AP reported even higher expected costs, though they didn\u2019t always provide a breakdown for how much is due to new Medicaid mandates and how much pertains to Supplemental Nutrition Assistance Program<\/a> changes also contained in Trump\u2019s big law.<\/p>\n Several states, including Arkansas, said they are still working on cost estimates for the Medicaid changes. Arkansas instituted a Medicaid work requirement in 2018-2019, and thousands of people were dropped from the rolls before a federal court ended it<\/a>. Many of the technology changes required by the new federal mandates could be covered under an existing vendor contract and have \u201ca minimal financial impact on our Medicaid budget,\u201d the Arkansas Department of Human Services said in an email.<\/p>\n Nebraska has said it plans to launch Medicaid work requirements<\/a> in May, seven months ahead of the federal deadline. But the state has not detailed any associated costs and did not respond to inquiries from the AP.<\/p>\n Georgia\u2019s work requirement prompts concerns<\/p>\n