Katie Crouch says calling her state\u2019s Medicaid agency to get information about her benefits can feel like a series of dead ends.<\/p>\n
\u201cThe first time, it\u2019ll ring interminably. Next time, it\u2019ll go to a voice mail that just hangs up on you,\u201d said the 48-year-old, who lives in Delaware. \u201cSometimes you\u2019ll get a person who says they\u2019re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there\u2019s just nobody on the line.\u201d<\/p>\n
She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn\u2019t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.<\/p>\n
Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she\u2019d been on the hook for them for the past three months, straining her family\u2019s fixed income, she said.<\/p>\n
Crouch\u2019s challenges with Delaware\u2019s Medicaid call center aren\u2019t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.<\/p>\n
Now, congressional Republicans\u2019 One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults \u2014 nearly all states and the District of Columbia.<\/p>\n
Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program\u2019s new work requirements but also verify more frequently that they qualify for the program \u2014 every six months instead of yearly.<\/p>\n
KFF Health News reached out to agencies that will need to stand up the work rules, and many said they\u2019ll need additional staff.<\/p>\n
The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they\u2019re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.<\/p>\n
States are already \u201cstruggling significantly,\u201d said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. \u201cThere will be significant additional challenges caused by these changes.\u201d<\/p>\n
Long Wait Times for Help<\/strong><\/p>\n Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.<\/p>\n The Congressional Budget Office estimated the rules<\/a> would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.<\/p>\n Many states don\u2019t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.<\/p>\n The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.<\/p>\n In December, about 30% of all Medicaid and Children\u2019s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia took more than 45 days<\/a> to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.<\/p>\n CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.<\/p>\n In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.<\/p>\n In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. <\/a>That Medicaid unwinding process didn\u2019t go well in many states,<\/a> and more than 25 million<\/a> lost their benefits.<\/p>\n Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.<\/p>\n \u201cIt is a much larger scale of administrative complexity,\u201d said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.<\/p>\n After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride\u2019s office contacted the state\u2019s Medicaid agency, which eventually called with an update, Crouch said.<\/p>\n Crouch didn\u2019t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.<\/p>\n \u201cIt makes absolutely no sense\u201d that the state never realized she shouldn\u2019t have been on the program, Crouch said.<\/p>\n Delaware\u2019s Medicaid agency didn\u2019t respond to requests for comment on Crouch\u2019s situation.<\/p>\n States Short-Staffed for Medicaid<\/strong><\/p>\n Some states told KFF Health News in late March that they\u2019ll need more staff to roll out the work rules effectively.<\/p>\n Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana\u2019s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.<\/p>\n As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.<\/a><\/p>\n Missouri\u2019s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago \u2014 with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made during a public meeting<\/a> in November.<\/p>\n \u201cThe department thought that there would be a gain in efficiency due to eligibility system upgrades,\u201d Bax said. \u201cMany of those did not come to fruition.\u201d<\/p>\n States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.<\/p>\n \u201cThey get yelled at a lot,\u201d said Brooks, who formerly ran New Hampshire\u2019s Medicaid and CHIP customer service program. \u201cPeople are frustrated. They\u2019re crying. They\u2019re concerned. They\u2019re losing access to health care, and so sometimes it\u2019s not an easy job to take if it\u2019s hard to help someone.\u201d<\/p>\n States are paying government contractors millions of dollars<\/a> to help them comply with the new federal law.<\/p>\n Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.<\/p>\n During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state\u2019s Medicaid program.<\/p>\n Maximus has \u201cno one-size-fits-all approach\u201d to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told KFF Health News.<\/p>\n The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, \u201cbecause of the additional transactions that will need to take place,\u201d David Mutryn, Maximus\u2019 chief financial officer and treasurer, said during the earnings call.<\/p>\n Losing Medicaid health coverage isn\u2019t just an inconvenience, since many people enrolled in the program probably don\u2019t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.<\/p>\n People could be unable to afford medications or get essential care, which could lead to \u201cdevastating\u201d health impacts, she said.<\/p>\n \u201cThe human stakes of this are people\u2019s lives,\u201d she said.<\/p>\n KFF Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. 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