Between 171,000 and 355,000 Michiganders are projected to lose Medicaid coverage under new work requirements and more frequent eligibility determinations established in the Trump Administration’s One Big Beautiful Bill Act.
That’s according to a research report published by the Urban Institute, a nonprofit organization based in Washington, D.C.
Medicaid is a public health insurance program serving low-income families and individuals and people with disabilities. It’s jointly funded by the federal and state governments.
The new requirements will go into effect in 2027. Many applicants will have to show proof they’ve worked or done other approved activities for 80 hours a month, and redeterminations of whether people are eligible to renew coverage will be required every six months instead of every year.
Matthew Buettgens, a senior fellow with the Urban Institute, said it’s typical for a certain number of people to get disenrolled when a redetermination process occurs.
The Urban Institute found that many people who meet the work requirements will still lose coverage because of “difficulty navigating administrative processes for reporting their work activities or exemptions.”
For example, Buettgens said, those who are self-employed could have a hard time verifying their income.
Individuals who are self-employed, have health conditions, or are 50 to 64 years old are more at risk of losing Medicaid coverage under the new policies, the Urban Institute said, and losing coverage can lead to worse health, financial burdens, barriers to employment, and delays or an inability to receive essential care.
“The benefits of having coverage are pretty broad across a number of different areas of life,” Buettgens said. “So, interruptions in that coverage could disrupt both health and financial security.”
The report estimates between 4.9 and 10.1 million fewer people across the country will be enrolled in Medicaid expansion coverage in 2028.
These numbers depend on the mitigation scenarios put forward by each state. High mitigation refers to policy choices that would use automatic data-matching to see if applicants meet the work requirements and eligibility redeterminations.
Low mitigation means the state has policies that require more individuals to take direct action and provide the state with documentation of their work hours — something the report indicates would result in more people losing coverage.
Buettgens said states can mitigate the impacts of these policies by defining exemptions from work requirements more flexibly, and limiting the amount of paperwork applicants need to submit.
