Since Congress passed legislation this year imposing new work requirements for some Medicaid recipients, The Maine Monitor has heard from readers who were concerned and confused about whether their insurance coverage would change. None of them had heard anything from the federal government about their status, although one received an email press release from the Social Security Administration that said it was “celebrating the passage of the One Big, Beautiful Bill, a landmark piece of legislation that delivers long-awaited tax relief to millions of older Americans.”
We decided to take three of their stories to health policy experts for insight. The experts could not provide definitive answers on any individual’s eligibility, but rather gave a general overview of their understanding of the new rules.
Here are the three profiles we collected:
Family 1
A 46-year-old woman who qualifies for Medicaid, which covers her psychiatrist, physician, counselor, medications and physical therapy related to her genetic disorder. She also qualifies for Medicare and Social Security Disability Insurance. She has not worked since a 2023 relapse. She receives $1,187 a month from disability, which is her only income.
Family 2
A 74-year-old woman who is raising her 15-year-old grandson, both of whom are on Medicaid. She also qualifies for Medicare and Social Security Disability Insurance. She receives supplemental insurance from Medicaid through the Qualified Medicare Beneficiary program. Her grandson is fully covered by Medicaid and receives counseling, medication management, case management and 3 medications. Their household income is $1,400 a month in social security and $400 from a pension. They also receive SNAP benefits.
Family 3
A 38-year-old woman and her 13-year-old daughter are both on Medicaid. The mother previously made about $12,000 a year when she worked, but she is currently in school with assistance from the Temporary Assistance for Needy Families program. Her brother, who is 36, also is on Medicaid. He also qualifies for Social Security Disability Insurance due to a diagnosis of autism. He hasn’t worked since 2023. His income is $1,283 a month, from disability. All three receive SNAP benefits.
Here is what the experts said:
Robin Rudowitz, vice president at KFF, a nonprofit health policy research organization, and director of the Program on Medicaid and the Uninsured, said many of these individuals likely would not be subject to the new work requirements because they are also on Medicare, over 65 or a low-income parent.
The new work requirements only apply to people in the Medicaid expansion population. States that opted into Medicaid expansion as part of the Affordable Care Act extended eligibility to include nearly all adults with incomes up to 138 percent of the federal poverty line ($21,597 for an individual this year), increasing those who are eligible beyond the mandatory groups that include low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income.
Nearly 400,000 Mainers are covered by MaineCare, the state’s version of Medicaid, and about 90,000 Mainers of them are in the expansion group.
Under the new work requirements, adults ages 19-64 who got coverage as part of the Medicaid expansion must log 80 hours a month of work, volunteering or half-time educational programs. The state has estimated the new rules will result in 31,000 Mainers disenrolling due to documentation hurdles and the unpredictable or seasonal nature of Maine’s heritage industries. The requirements will go into effect on Jan. 1, 2027.
There are exemptions to the work requirements for parents of children 13 and younger, those who are pregnant or postpartum, and the “medically frail.” Medically frail includes people with physical, intellectual or developmental disabilities, substance use disorder, a “disabling” mental disorder and “serious or complex” medical conditions, according to KFF.
Dr. Patrick Connolly, a family physician at Martin’s Point and co-chair of the Maine Medical Association legislative committee, agreed that most of the people The Monitor spoke to likely would not be subject to additional work requirements. But their confusion about their coverage still presents a barrier to care, he said.
“You have these three case scenarios and they’re worried that they might lose their health care,” Connolly said. “That worry in and of itself presents a barrier: ‘I’m not sure I want to go to the doctor (because) I may not be covered.’ ”
Medicaid applications are already “cumbersome” so the more complicated the government makes it, the more likely people are to fall through the cracks, he said. In addition, the legislation passed by Congress is estimated to cut $186 billion from SNAP funding through 2034. People already are having to choose between eating and taking their medicine, Connolly said.
The result will be patients will wait longer to visit their doctors, or won’t go at all, and will end up in the emergency department, he said. Maine already has among the highest rates of emergency department visits in the country.
“If you put up artificial barriers – the barriers of lack of coverage or the worry of lack of coverage – people are going to be sicker and we’re going to spend more in the long run because the complications cost way more to treat than the problems upfront,” Connolly said.
