Medicaid Work Requirements (2027)

CMS guidance requiring 80 hrs/month work/activities for Medicaid eligibility. States scrambling; new state-level impact analysis shows concrete implementation challenges. Montana early implementation shows caregiver forced off Medicaid, rural nursing homes squeezed. Lawsuits filed. States consider charging companies with workers on Medicaid to offset costs (NJ enacted, CA exploring). Could strip coverage from millions. New: Deloitte-run Medicaid systems denied disabled people due to IT errors; OBBBA requirements will strain these systems, worsening access. OBBBA's Medicaid cuts create border divide in mental healthcare access (Oregon/Idaho case study: clinic closures, jail as default). Kentucky Medicaid implementation lessons highlight operational coordination challenges. Also: CMS proposed provider tax rule could slash $246B from Medicaid, threatening state healthcare access; comment deadline approaching. Court blocked several ACA marketplace rule changes that would have raised costs.