Health Announce: Protecting Medicaid 🚨

In today's special edition Health Announce on protecting Medicaid:

1. The Threat to Medicaid: Republicans' Reconciliation Bill
   1. Six month renewal periods
   2. Work requirements
   3. Restrictions targeting immigrants
2. Action Steps: field calls and phone banks starting TODAY
3. Resource List

The Threat to Medicaid: Republicans' Reconciliation Bill

For months, Republicans have been floating ideas on how to cut Medicaid. Now, with the release of the House Energy and Commerce Committee (E & C) and House Ways and Means (W & M) markups for the reconciliation bill, we have in writing more details on how they intend to do it. Late Sunday, the House budget committee advanced the reconciliation bill with more Medicaid cuts added to win over Republican hard-liners. The next stop is the House Rules Committee.

We must speak loudly and clearly about how exactly these policy changes will harm people’s access to health care, leaving our communities less healthy and less secure.

The E & C and W & M bill contains a slew of harmful policy proposals. MassHealth sources told State House News (subscription required) that the E & C bill alone would cost the state $1 billion in lost federal Medicaid funds. A recent state-by-state estimate of Medicaid enrollment losses from the E & C bill puts the number of people losing MassHealth at up to 279,000. This Health Announce focuses on three cuts that would result in significant harm to members and our communities:

1. 6-Month Renewal Periods,
2. Work Requirements, and
3. Restrictions Targeting Immigrants.

See the resource list below for additional analysis on the myriad proposals in the E & C and W & M bills, and the action steps you can take to protect Medicaid- starting today!

Six Month Renewal Periods for Medicaid Expansion Adults

Currently, MassHealth conducts redeterminations once a year to evaluate whether a member continues to be eligible. Republicans want to force MassHealth to do this every 6 months. This change goes along with other provisions repealing rules finalized during the Biden administration designed to improve the eligibility and enrollment process.

Requiring more frequent eligibility checks will result in many losing health coverage for no other reason than struggling with the increased red tape and paperwork burden. We know this because of the recent experience with the unwinding after Covid protections ended. Of the enrollees processed during the unwinding, nearly 30% were disenrolled for procedural reasons – that’s 449,513 who lost their healthcare coverage because of administrative reasons.

Don’t believe the spin: Republicans claim this policy change is aimed at reforming Medicaid, but the goal is and always has been to cut Medicaid spending, which will leave thousands across Massachusetts – and millions across the US – without health insurance.

Harm to Massachusetts:

• Thousands who qualify for coverage will be procedurally or administratively terminated
• Increased MassHealth administrative costs – significant workforce and system capacity improvements will be required to double the number of redeterminations each year
• Millions of dollars will be diverted away from direct care into red tape

Work Requirements as a Condition of Eligibility for the Medicaid Expansion Population for Individuals Aged 19 to 64

The E & C bill would require MassHealth to impose costly and burdensome work requirements on individuals aged 19-64. Members and applicants would have to work at least 80 hours per month (or 80 hours of a work program or community service, or participate in at least a half-time educational program). Applicants would have to prove that they met the work requirement for at least one month before they applied. Members would have to prove they meet the work requirement at least once every 6 months (at renewal). Anybody falling under one of the exceptions, including those who are pregnant, disabled, caretakers, or have certain special health needs, would need to prove that they meet those exceptions. An earlier effective date for this provision is subject to ongoing negotiations.

• Make no mistake- Republicans are counting on work requirements to kick eligible people off Medicaid. Nearly three-quarters of adults 19-64 on MassHealth already work- and those who don’t are disabled, care-takers, between jobs, or otherwise unable to work. Though work requirements target only a small percentage of people, work requirements force everybody to jump through burdensome hoops to get and keep coverage.
• Past experience shows that work requirements don’t work. In Arkansas’ Medicaid program, a work requirement resulted in thousands losing coverage: only 7% of them lost coverage because they did not meet the work requirement; the other 93% lost coverage because of red tape. After spending over $26 million to implement the work requirement, Arkansas saw no significant changes in employment.
• These work requirements are a job loss penalty. People on unemployment insurance and actively looking for a job are not excluded from this requirement. Taking health coverage away from people during periods of unemployment is backwards: it puts them at risk of having their health interfere with their ability to secure another job.
• Work requirements cost money. Forcing states to verify members’ work statuses and exemptions shifts money away from health care into administrative red tape. Taking money away from health care will have ripple effects across Massachusetts’ economy and will destabilize our health care delivery system: nearly 20% of Massachusetts hospitals’ patient revenue, and 50% of Community Health Centers’ patient revenue come from MassHealth.

Eligibility Restrictions Targeting Immigrants

The House E & C and W & M Committee bills will end federal support for many lawfully present immigrants now eligible for Medicare and Advance Premium Tax Credits and seek to punish states like Massachusetts that have used their own state funds to cover immigrants not eligible for Medicaid or premium tax credits. The Committee’s bill will –

1. Take earned Medicare benefits away from immigrants who were authorized to work, paid into the system and are still lawfully present in the US but are not green card holders. Meanwhile, other changes by the Judiciary Committee will make it much more difficult and expensive for anyone with a path to a green card to ever obtain one. (W & M)
2. Restrict the eligibility of many lawfully present immigrants for premium tax credits that bring down the cost of private insurance purchased through a Marketplace like the Health Connector (W & M). It will end coverage for green card holders and other lawfully present immigrants with income under the poverty level. For immigrants with income over the poverty line, it will end coverage for all categories of lawfully present immigrants except green card holders. In Massachusetts this means -
   1. Ending ConnectorCare coverage for 30,000 low income immigrants including green card holders in 2026, and
   2. For immigrants with income over the poverty line, applying restrictions on all but green card holders with income too high for Medicaid in 2027. This will take current ConnectorCare coverage away from domestic violence victims, trafficking victims, refugees and people granted asylum as well as other lawfully present work-authorized immigrants not eligible for Medicaid, like people with Temporary Protected Status, Crime Victims (U-visas) and DACA (“Dreamers”).
3. Reduce the federal matching rate for Medicaid Expansion adults from 90 percent to 80 percent as a cruel and cynical punishment for states that use their own state funds to provide health coverage to any group of immigrants, including pregnant women and children, who are not eligible for federally reimbursed health benefits because of their immigration status. (E & C). In Massachusetts this will mean -
   1. Withholding over $350 million in federal Medicaid matching funds for adults eligible under the ACA Medicaid Expansion (CarePlus). MassHealth Careplus has an expected FY 2026 gross budget of over $350 billion.

2. Action Steps:

1. Three Days to Save Medicaid National Field call TODAY, May 19 at 3:00 pm ET by Families USA: register here.
2. SEIU Code Blue Events, Messaging and Resources - including virtual Medicaid #SAVESLIVES phone banks and text banks to target district voters. The phonebank is open May 19-21 5PM - 8PM (ET) and 5PM - 8PM (PT). Click here to RSVP.
   1. Health Care for All is coordinating in MA. Sign up for here to RSVP for calls this week on May 19, 21 and 22
3. Virtual Town Hall TODAY, May 19 at 7:30-8:30pm ET, led by Public Citizen and Americans for Tax Fairness to mobilize members of the tax, human needs, health care, environment, immigration, and other sectors against the reconciliation bill. Click here to join.
4. Another National Call-in Day on Tuesday, May 20. Stay tuned for more details.

3. Resource List:

1. Families USA section by section analysis of E&C bill
2. Kaiser Family Foundation:
   1. Tracking the Medicaid Provisions in the 2025 Reconciliation Bill
   2. Potential Impacts of the House 2025 ReconciliatIon Bill on Immigrant Families
3. Caring Across Generations Protect Medicaid 2025 Toolkit
4. SEIU National Save Medicaid Text Banks (External)