It is expected that the first mandatory work requirement for the beneficiaries of Medicaid, approved by the Congress led by the Republicans and signed by President Trump, to have a seismic effect in California.
An estimate of state health officials suggests that up to 3.4 million people could lose their insurance through what Governor Gavin Newsom calls the “maze of manual verification”, which involves the beneficiaries of Medi-Cal that demonstrates every six months they are working, going to school or voluntarily at least 80 hours per month.
“It will be much more difficult to stay insured,” said Martha Santana-Chin, director of the Care Health Plan, a publicly operated health plan that serves about 2.3 million patients medi-Cal in Los Angeles County.
She said that up to 1 million people, or around 20% to 40% of its members, could lose their coverage.
The work requirement will be the first imposed throughout the country in the history of six decades of Medicaid, the program that provides free and subsidized health insurance to disabled and low -income Americans.
It is a relatively unknown territory, and it is not yet clear how the rules will shake for the 5.1 million people in California who will be required to prove that they are working to qualify for Medi-Cal, the version of the state of Medicaid.
After the mid -period elections of 2026, it will be required that millions of healthy adults demonstrate every six months that meet the work requirement to qualify for Medicaid. The new mandate explains some exceptions, even for pregnant people, in the treatment of addictions or the care of children under 14 years.
Democrats have long argued that work requirements generally lead to eligible people who avoid their health insurance due to bureaucratic obstacles. Republicans say that a work requirement will encourage healthy people to get a job and preserve Medicaid for those who really need it.
“If you clean it and sign it, you save a lot of money,” said the president of the House of Representatives, Mike Johnson de Louisiana. “And you return the dignity of work to young men who need to be working instead of playing video games all day.”
Only three US states have tried to implement the work requirements for Medicaid recipients: New Hampshire, Arkansas and Georgia. A study found that in the first three months of the Arkansas program, more than 18,000 people lost health coverage.
People can lose coverage in several ways, said Joan Alker, a professor at Georgetown University who studies Medicaid. Some people listen that the rules have changed and assume that they are no longer eligible. Others struggle to demonstrate their eligibility because their income fluctuates, they are paid in cash or their works do not maintain good payroll records. Some have problems with technology or forms, he said, and others do not appeal their rejections.
Of the 15 million people in Medi-Cal in California, approximately one third must demonstrate that they are working, the state said. These people earn very little: less than $ 21,000 for one person and less than $ 43,000 for a home of four.
The estimation of the state of 3.4 million people who lose coverage is a projection based on what happened in Arkansas and New Hampshire.
But those programs were brief, revoked by the courts and were not “a coordinated effort between the states to discover what are the best practices,” said Ryan Long, director of relations with Congress at the Paragon Health Institute, a group of conservative experts that has become influential among the Republicans of the Congress.
Long said advances in technology and a national emphasis on work requirements should make work verification less a barrier. The budget bill includes $ 200 million in subsidies for states to update their systems to prepare, he said.
The arguments of the liberal groups that people will lose medical attention are an “argument of the straw man,” said Long: “They know that the public supports the work requirements for these benefits, so they cannot leave and say: 'We do not support them'.”
A survey conducted by the KFF Health Research Group found this year that 62% of American adults support Medicaid's eligibility with work requirements.
The survey also found that support for politics falls to less than 1 in 3 people when respondents listen to “that most people in Medicaid are already working and many would run the risk of losing coverage due to the burden of testing eligibility through paperwork.”
In June, Newsom warned that some Californians could be forced to complete 36 paperwork pages to keep their insurance, showing journalists an image of a battery of forms with blue green and gold accents that described as “an example of real PDF of the paperwork that people will have to send for their eligibility checks.”
Many Californians must already complete that the 36-page form or its online equivalent to register in medi-in and covered in California, the state health insurance market.
Experts say that it is too early to say which system will be used so that people try their labor eligibility, because the federal guide will not end for months.
The Newsom office addressed the Department of Medical Care Services, which is executed by Medi-Cal. A spokesman said that officials “are still reviewing the complete operating impacts” of the work requirements.
“The idea that you are going to receive a paper presentation every six months, I'm not sure people have to do that,” Long said.
Georgia is the only state that has implemented a lasting work requirement for Medicaid. Two years ago, the State made available to health for people who worked at least 80 hours per month and gained less than the federal poverty limit (around $ 15,000 for a person or $ 31,200 for a home of four).
More than 100,000 people have requested coverage since the launch of the program in July 2023. As of June of this year, more than 8,000 people were registered, according to the most recent data in the State.
The Medicaid program has cost more than $ 100 million so far, and for that, $ 26 million were spent on health benefits and more than $ 20 million were assigned to marketing contracts, said Kff Health News. Democrats in Georgia have sought an investigation into the program.
The Inland Empire agency that provides Medi-Cal coverage for approximately 1.5 million people in the counties of San Bernardino and Riverside estimated that 150,000 members could lose their insurance as a result of the work requirements.
Jarrod McNaughton, executive director of the Health Plan of the Inner Empire, said that the 58 County County, who manage Medi-Cal, “will be those that are in the precipice of joining this”, but that they have not yet received guidance on how the eligibility process or what information will have to provide the people will be established.
Will it be done online? Will the recipients be required to complete a piece of paper that must be sent or left by mail? “We really don't know the process yet, because all this is very new,” said Naughton.
Meanwhile, he said, the foundation of the Health Plan is working to make this “less onerous possible”, working to improve community dissemination and connect people who receive medi-Cal insurance to be volunteers.
