\u201cThe main challenge, at least in Massachusetts, is it\u2019s trying to prepare for a program it\u2019s never run, on a timeline it didn\u2019t choose, without the federal guidance it needs to make key decisions,\u201d said Dr. Rishi Wadhera, a Harvard Medical School assistant professor who studied the people most likely to suffer under new Medicaid restrictions.<\/p>\n
Elizabeth LaMontagne, chief operating officer for the state\u2019s Medicaid administrator, MassHealth, is more optimistic. Work is underway, and the state has nailed down some specifics since the KFF survey. <\/p>\n
She also noted that the January deadline only applies to new enrollees. The work requirement won\u2019t apply to current Medicaid recipients until their routine renewals, which will be staggered throughout the coming year. <\/p>\n
\u201cWe are in really good shape for launch come January,\u201d she said. \u201cWe\u2019ve got a proven track record of doing good work on this kind of really complicated campaign.\u201d<\/p>\n
![\"A](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/05\/B5RYCPXJYUHM63KPM6NIFPR4EI.jpg\")
A man enrolls for Medicare on Jan. 8, 2024.JAMIE KELTER DAVIS\/NYT<\/p>\n
The new requirements and additional eligibility checks were part of the Big Beautiful Bill signed into law by President Trump last year. The Congressional Budget Office<\/a> projected the requirement would save about $326 billion over a decade and would cost 5 million people nationwide their insurance. <\/p>\n In order to automate eligibility checks, states must identify new data sources they\u2019ll use to verify income, community service, school enrollment, and medical status.<\/p>\n In March, Massachusetts was among 22 states that told KFF it had not yet determined what new data sources it would use. It also said it faced insufficient funds, staff, and time and was struggling to complete data sharing agreements.<\/p>\n In an interview last week, LaMontagne said MassHealth had made progress since then. It is linked to the Department of Revenue\u2019s wage data and plans to be able to communicate with at least five additional databases, including data maintained by the Department of Transitional Assistance, Veterans Affairs, and the National Student Clearinghouse. MassHealth has access to claims data it will use to confirm medical frailty, officials said.<\/p>\n \u201cWe will have those datasets integrated before this program goes live,\u201d said LaMontagne. <\/p>\n Derek Winbush, 63, of Boston, worries about the coming work requirements. He is part of a large population of people with chronic health conditions who are too unwell to work steadily but don\u2019t qualify for a disability exemption. Winbush has cirrhosis, kidney disease, nerve damage in his feet, vision problems, vertigo, and is HIV positive. He\u2019s the kind of person whose Medicaid coverage may hinge on what is considered medical frailty. <\/p>\n Winbush doubts he would be required to work to maintain coverage, but if he were, he would lose his insurance. His health issues would make it impossible for him to hold down a job, he said. And his health would almost immediately decline without coverage. He takes 11 pills a day to manage his conditions, he said, and has doctor appointments every month. <\/p>\n \u201cIt\u2019s probably life or death with me,\u201d he said. \u201cIt\u2019s that serious.\u201d <\/p>\n As a volunteer board member for Boston Health Care for the Homeless, Winbush stays informed about Medicaid policies. Many of the people most vulnerable to losing their coverage next year \u2014 people living with homelessness or addiction, most of whom suffer from mental health conditions \u2014 are completely unaware of the major changes less than a year away, he said. <\/p>\n \u201cThey don\u2019t have a clue,\u201d Winbush said. <\/p>\n MassHealth is preparing an outreach campaign this summer, including a new website that will give Medicaid members details about eligibility. Some of the people Winbush described will require direct outreach and assistance, but the work will be infinitely easier if the state can automate many eligibility checks. <\/p>\n The state\u2019s problems could be mitigated this summer if the Legislature supports a provision in the governor\u2019s budget proposal to spend $30 million to preserve health care access in the state, MassHealth reported. If approved, more than two-thirds of that money would support building connections with databases and vendors to help people navigate new requirements. Another $6.2 million would pay for about 70 new employees who would help people gain or keep Medicaid coverage, or appeal denials of coverage. <\/p>\n The hope, experts said, is that CMS recognizes states are facing an impossible deadline and will make it relatively easy to get exemptions at least through 2027. Self-attestation, allowing a member to assert an exemption without providing supporting documents, at least temporarily, is a possibility, even though Dr. Mehmet Oz<\/a>, the CMS administrator, has said he would prefer not to allow it.<\/p>\n A CMS spokesperson also said the agency committed more than $600 million to pay for products and services from health technology companies to aid states and is distributing to states $200 million in grant money to help them prepare for the new requirements.<\/p>\n At UMass Memorial Health, where 27 percent of the system\u2019s patients are on Medicaid, decisions about who is and isn\u2019t subject to a work requirement will shape how the hospital approaches keeping as many patients as possible insured, said Dr. Eric Dickson, the hospital\u2019s chief executive. <\/p>\n \u201cWe need to very quickly figure out what the rules are going to be,\u201d he said. \u201cWe don\u2019t know how bad it\u2019s going to be, but we know it\u2019s going to be bad.\u201d<\/p>\n Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>.<\/p>\n