Tens of thousands of West Virginia residents will lose their Medicaid coverage in 2028 due to new work requirements and more regular eligibility reviews, according to a study released last week. (Photo via Getty Images)
Between 40,000 and 75,000 West Virginia residents will lose their Medicaid coverage in 2028 due to new work requirements and more regular eligibility reviews that take effect next year, according to a study released last week.
The government measures will lend a hand determine whether the decline is closer to the low estimate, the high estimate or somewhere in the middle, the study said.
The Urban Institute conducted the analysis with support from the Robert Wood Johnson Foundation. The study estimates that between 4.9 million and 10 million people nationwide will lose their health insurance coverage when the new work requirements and six-month revisions take effect.
“The reason for the range is that the extent of coverage losses depends heavily on state policy and how states implement policy,” said Jennifer Haley, senior research fellow at the Urban Institute.
Beginning January 1, 2027, individuals ages 19 to 64 who are in the Medicaid expansion group must work or exercise 80 hours per month to qualify for the program. Expanded Medicaid covers those who qualify for the program because they make up to 138% of the federal poverty level, which is about $45,540 for a family of four.
Currently, 161,184 state residents are part of the Medicaid expansion population, a spokeswoman for the state Department of Human Services said Monday.
Currently, states are required to determine a person’s eligibility once a year, but that number will be increased to twice a year.
The policy changes are part of the One Big Beautiful Bill Act, which President Donald Trump signed into law last year. West Virginia entire Congress- The delegation – all Republicans – voted for the One Big Beautiful Bill Act, which the Congressional Budget Office estimates will reduce federal spending on health care by $1 trillion over 10 years and cause 10 million people to lose their health insurance.
Condition Medicaid officials told lawmakers last year The work requirements would result in a drop in enrollment, but it did not say by how much. The The state hired the West Virginia University Health Department to assist with project management and system requirements for the work requirements, officials said. Officials said at the time that the work requirements may force the state to modernize its systems and hire more staff.
If West Virginia implements a “high mitigation” strategy to lend a hand people stay on Medicaid, enrollment will only decline by 40,000. However, if authorities opt for a “low mitigation” plan, the number could be as high as 75,000, according to the study. Under what researchers call the “medium mitigation scenario,” state Medicaid enrollment would drop by about 61,000 people.
Haley said states have some flexibility in implementing the work requirements, including requiring people to meet the work requirements for a month before they are eligible or to meet them for three months.
“Many low-income people have work experiences that vary over time,” Haley said. “Wages can go up a little bit or go down a little bit in a given month depending on how many hours they’re supposed to work. So that income volatility is one of the reasons that people may be noncompliant as states check their eligibility more frequently.”
States can also exploit automatic or ex parte extensions, using records from taxes or other public assistance programs rather than requiring people to submit paperwork, to better mitigate enrollment setbacks.
“This is going to be really important to reduce the loss of coverage with these more frequent redeterminations,” Haley said.
She added that it is critical for Medicaid enrollees to update their address if necessary so that the state agency can contact them if they need more information.
Some people are exempt from the work requirements, including students, pregnant women, parents of children ages 13 and younger, and people the state deems “medically frail.”
Haley said states have the opportunity to define medical frailty broadly and expand the time frame in which they look for claims to demonstrate medical frailty.
“For example, if you look at a single month’s health insurance claims, that wouldn’t capture all people with health problems because not all of them likely saw a provider in a single month,” Haley said. “But if you go back a full year or two years and examine claims to identify diagnoses that could indicate medical frailty to Medicaid, that would likely result in more people being identified as medically frail.”
In a statement to West Virginia Watch, Angelica Hightower, communications specialist with the state Department of Human Services, said the agency is focused on ensuring compliance with federal requirements while continuing to support West Virginians who rely on Medicaid.
“DoHS is working diligently to meet the January 1, 2027 deadlines associated with new federal requirements, including work requirements and eligibility redeterminations,” she said.
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