H.R. 1 Medicaid Work Requirements and ACA Changes Expected to Drop 14 Million from Coverage
Federal legislation (H.R. 1) cuts $1 trillion from Medicaid over ten years, imposes work reporting requirements and six-month redeterminations for expansion adults starting January 2027, and eliminates automatic ACA Marketplace re-enrollment. Enhanced premium tax credits expired January 1, 2026. The Congressional Budget Office projects 14 million people will lose coverage over the next decade, with Medicaid work requirements alone projected to disenroll 6 million. Healthier enrollees are expected to disproportionately exit, worsening risk pools in both Medicaid and Marketplace plans and driving premium increases. New retroactive coverage limits and cost-sharing for expansion adults take effect October 2028.
Medicaid managed care organizations face large-scale membership losses, adverse selection as healthier members exit, and increased administrative burden from work reporting verification and twice-yearly redeterminations starting 2027.
Managed Care · Finance
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