In almost exactly six months – January 1, 2027 – new federal rules go into effect for people receiving Medicaid, likely causing disruption that experts worry will be chaotic and expensive.
Among the changes in the large budget bill passed by the Republican-led congress last summer: people getting Medicaid must work 80 hours a month (if they don’t have an exemption) and must get re-certified every six months, instead of the current once-a-year process. This is connected to billions of dollars in cuts made to the government program.
The Blue Cross Blue Shield of Massachusetts Foundation estimates that 200,000 state residents could lose MassHealth coverage (the state’s version of Medicaid) and are unlikely to replace it with another insurance.
In Western Massachusetts, community health centers are trying to prepare for the shift, which they say will make it harder not only for many people to get care but for health centers to pay their bills. And experts warn the repercussions will go well beyond community health centers, since emergency rooms will likely be more crowded with the uninsured and more expenses across the health care system will be uncompensated.
Allison Van Der Velden is CEO of the Franklin County Community Health Center, which serves a large percentage of people on MassHealth. She said they still don’t know how the state will implement the rules; for instance, what proof for work requirements will they require, and how often?
“All these details really actually have a big impact on the day to day work of keeping folks who are eligible covered,” she said. “So we're all just kind of waiting to see what it will look like.”
One thing they do know, she said, is that staff will spend much more time helping people with all the new paperwork, an expense that is unlikely to be reimbursed. And if patients lose coverage, the health center won’t get paid for a lot of the care they are still legally required to provide.
“What we're doing to prepare is really just putting forth a conservative budget that anticipates more stress,” Van Der Velden said.
She said some services, like dental, could be cut. They may also have to scale back support services, like transportation, which could make getting to appointments much more difficult in rural areas of western Massachusetts.
At the same time, Van Der Velden said they are planning to invest more in the kinds of services that bring in revenue, including primary care and their pharmacy business.
Kaitlin Kenney Walsh, president of the Blue Cross Blue Shield of Massachusetts Foundation, said that while many MassHealth recipients would still be eligible for the program under the new rules, they may not understand how to prove it, especially since “navigator” services have also been cut from budgets.
“The vast majority of non-elderly people on MassHealth are in working families, but this is a new requirement," Kenney Walsh said. "And so people may not be aware that they need to document their work or community engagement hours.”
That's why she urges the state and private foundations to give money to community organizations, especially social service or faith-based ones that can reach out to the most vulnerable populations, including immigrants, low-income workers, and communities of color.
On June 29, 2026, the Massachusetts Attorney General joined 25 other states in suing the federal government over the new Medicaid work requirements, focusing on an interim rule change they say further complicates states' efforts to comply. They say it will also make it harder for disabled people to keep their health coverage. The plaintiffs are asking the courts to block implementation of the interim rule.
