Millions of Americans who rely on Medicaid for health insurance are less than seven months away from a major eligibility change — and most have no idea it is coming.

A new survey from The Health Management Academy, an Arlington, Virginia-based research organization, found that 55% of Medicaid enrollees are completely unaware that work requirements will become a condition of eligibility beginning January 1, 2027. Another 27% said they had heard about the changes but did not understand the details.

The survey, conducted in April 2026, included 1,974 adults enrolled in Medicaid and highlights a growing concern among policymakers, hospitals, and insurers that millions of eligible Americans could lose coverage simply because they fail to complete new reporting requirements.

What the New Rules Require

Beginning in 2027, many adults covered through Medicaid expansion programs will be required to document at least 80 hours per month of qualifying activities.

Those activities can include:

• Employment
• Job training
• Education
• Community service
• Other approved activities

The requirement generally applies to adults ages 19 through 64 enrolled through Medicaid expansion programs.

Individuals who fail to meet the requirements — or fail to properly report them — could lose their health coverage.

The policy was included in last year’s federal budget legislation, often referred to as the “Big Beautiful Bill,” and represents one of the most significant changes to Medicaid eligibility in years.

According to projections from the Congressional Budget Office, the legislation is expected to produce the largest reduction in federal Medicaid spending in the program’s history.

Most Enrollees Have Heard Little or Nothing

The survey suggests awareness remains extremely low.

Nearly 48% of respondents said they had heard “nothing at all” about recent Medicaid eligibility changes.

Another 32% said they had heard only “a little.”

The confusion extends beyond work requirements.

Approximately 85% of respondents said they were unaware that states will be required to verify Medicaid eligibility every six months under the new rules.

Awareness also varies significantly by geography and demographics.

In Oregon, about 78% of respondents said they knew about the upcoming work requirements. In Nebraska, where implementation began early in May, awareness was closer to half.

Among demographic groups, Black Medicaid enrollees reported the highest level of unawareness, with 62% saying they did not know about the coming requirements.

Policy experts warn that many people who already meet the standards could still lose coverage if they fail to complete paperwork or do not realize reporting will be required.

Why Hospitals Are Concerned

The issue extends well beyond individual patients.

Hospitals — particularly rural hospitals — depend heavily on Medicaid reimbursement.

If large numbers of patients lose coverage, hospitals could see a rise in uncompensated care while receiving less reimbursement revenue.

The survey found that 42% of respondents said they could not travel farther than they currently do for hospital care if their nearest hospital closed.

Among respondents with chronic medical conditions, about 25% said a local hospital closure would make managing their condition significantly more difficult.

Rural healthcare providers have repeatedly warned that reductions in Medicaid enrollment could place additional strain on facilities already operating on thin margins.

Medicaid Insurers Face New Financial Pressure

The changes could also affect the nation’s largest Medicaid managed-care insurers.

The five largest players in the market —

Centene, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group —

collectively manage roughly half of all Medicaid managed-care enrollment nationwide.

According to Fitch Ratings, the new rules may create revenue pressure for insurers while increasing the overall cost of covering the remaining Medicaid population.

If healthier individuals lose coverage because they fail to complete reporting requirements, the remaining pool could become older and sicker on average, driving up healthcare costs.

That dynamic could force states to increase payments to insurers to maintain program stability.

Some executives have sought to reassure investors.

Molina Healthcare CEO Joe Zubretsky recently said the impact should be gradual, noting that roughly two-thirds of Molina’s 1.3 million Medicaid expansion members already work and many others may qualify for exemptions.

The Bottom Line

The survey highlights a fundamental challenge facing states, healthcare providers, and insurers: a major policy change is approaching, yet most Medicaid recipients remain unaware of it.

Whether the new requirements ultimately reduce enrollment dramatically or only modestly, the next several months will likely determine how many eligible Americans keep their coverage — and how many lose it because they never realized the rules had changed.

JBizNews Desk — Healthcare

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