Medicaid and SNAP eligibility, work rules, and reconciliation cuts

Medicaid's 80-hour monthly work requirement and six-month expansion renewals begin in January 2027, with CBO estimating roughly 5.2–5.3 million coverage losses. Missouri's hardship-exemption decision, Iowa's December 1 start, Indiana's waiver and compliance problems, and state guidance in Pennsylvania and New York sharpen the risk of paperwork-driven disenrollment. New analysis highlights implementation differences across 44 states, while CMS's rescission of the HRSN waiver framework creates added uncertainty for housing, nutrition, and behavioral-health supports. SNAP states face administrative and budget pressure, including a potential October 2027 cost-sharing policy for states above the 6% error threshold.