States preparing to implement the new Medicaid work requirements authorized by the One Big Beautiful Bill Act face significant staffing shortages and administrative hurdles that could disrupt access to benefits for millions of enrollees. The federal law, signed last year by President Donald Trump, requires states that expanded Medicaid to verify work activities or exemptions every six months, increasing the workload on already stretched Medicaid agencies.
The new rules are scheduled to take effect January 1, 2027, and will require Medicaid agencies in nearly all states and the District of Columbia to conduct more frequent eligibility checks and confirm compliance with work requirements. This is expected to substantially increase demand on state personnel who handle enrollment and customer service, according to state officials and health policy experts.
Staffing Shortages and Administrative Challenges
States specializing in Medicaid report extensive vacancies among eligibility workers, customer service staff, and case managers. For example, Idaho has 40 eligibility worker vacancies, New York expects to hire 80 new employees to manage the added workload, and Pennsylvania reports nearly 400 open positions in county human services offices. Other states such as Indiana, Maine, Massachusetts, and Montana have expressed similar difficulties in filling staffing needs before the rules take effect.
State Medicaid call centers are already overwhelmed, contributing to long wait times and delayed application processing. CMS data from December 2025 shows that 30% of Medicaid and CHIP applications in Washington, D.C., Georgia, and Wyoming took longer than the federally recommended 45-day processing time. Phone wait times in some states have exceeded an hour, with Hawaii recording more than three hours of hold time.
Consumer advocates warn that these staffing shortages and the complexity of the new work verification process may result in eligible beneficiaries losing coverage unintentionally. This risk follows a recent period of Medicaid “unwinding” after pandemic protections expired, during which more than 25 million people lost benefits nationwide.
Impact on Medicaid Enrollees
The increased administrative burden will not only delay services but could also produce coverage gaps for low-income and disabled populations who depend on Medicaid for essential health care. Many enrollees have limited income and may not qualify for Affordable Care Act subsidies, heightening the consequences of losing Medicaid benefits for medications and treatment.
Examples like Katie Crouch from Delaware illustrate these challenges. Despite ongoing interactions with her state Medicaid agency, Crouch faced months of unanswered calls regarding eligibility and eventually learned she was no longer qualified—information that had never been communicated clearly before. This experience highlights systemic problems with communication and case management that the new rules could exacerbate.
Why it matters
The expanded work requirements represent one of the most significant Medicaid policy changes in years, projected to reduce federal Medicaid spending by nearly $1 trillion over eight years. However, they also threaten to disrupt coverage for millions of vulnerable Americans during a period of persistent economic uncertainty.
Health policy researchers note that previous Medicaid work requirement programs showed little evidence of increasing employment, raising questions about the effectiveness of the policy relative to its administrative cost and human impact.
States are investing in contractor support to meet these challenges. Companies like Maximus are providing eligibility support and call center services, with revenues tied to transaction volumes rather than enrollment numbers, indicating that increased administrative activity may continue even if enrollment declines.
Background
The Medicaid program provides health insurance for low-income individuals, including people with disabilities and older adults. After the Affordable Care Act, many states expanded Medicaid to cover more low-income adults, increasing enrollment substantially.
During the COVID-19 pandemic, Medicaid enrollees were protected from losing coverage due to job loss or fluctuating income. The recent expiration of these protections required states to review eligibility more closely, a process known as “unwinding,” which has already led to large enrollment declines due to administrative barriers.
The new work requirement policy builds on this trend but imposes stricter compliance demands, requiring states to verify that adult Medicaid enrollees meet certain work or community engagement criteria to maintain their benefits.
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