More than 2 million young adults could lose Medicaid soon

More than two million young people between the ages of 19 and 24 could lose Medicaid in the next couple of years as new work requirements and more frequent eligibility checks phase in, according to a new analysis from the Urban Institute.

This is in the 40 states plus Washington, D.C. that have expanded Medicaid, where low-income adults who don’t have kids or a disability are able to get free or low-cost health insurance through the government. And it’s despite the fact that Urban found nearly 90% of young adults should be eligible to keep their coverage under the new rules.

“Just by virtue of people having to do more paperwork, you see these dramatic estimates of the number of people who will lose their coverage,” said Leo Cuello, a research professor at the Georgetown University Center for Children and Families. “That's nothing to do with underlying eligibility. It's just the processes that trip them up.”

Starting Jan. 1 in most states, in order to keep their insurance, low-income adults on Medicaid will have to prove they’re some combination of working, volunteering, or in school at least 80 hours a month, or that they should be exempt from that requirement because they’re a caregiver, have a disability, or are too sick to work. They will also have to submit proof of eligibility and proof of income twice as often as they do now — every six months instead of once a year. These are just some of the changes to Medicaid that Congress passed last year as part of the One Big Beautiful Bill Act.

“Young adults might face particular challenges with these new changes,” said Jennifer Haley, a principal research associate at the Urban Institute and lead author on the report.

For one, many young people do gig work or seasonal work and have inconsistent hours or income, which can be hard for states to verify automatically. And that means more paperwork more often.

They’re also more likely to be in school, Cuello said, “which means that if a state doesn't have a good system for doing automatic data matches for school, again they're going to have to do a lot of reporting to show that they're in school.”

Plus, many people in their late teens or early 20s are new to all the admin required to get and keep insurance.

When you’re that age, it’s also common to move around a lot, “because you haven't settled into a job or a place to live,” said Betsy Cliff, an assistant professor in the Department of Public Health Sciences at the University of Chicago.

And that can be a barrier to keeping health coverage.

“It's much easier to stay enrolled in Medicaid if your life is more stable,” she said. “So if you keep the same address, if you keep the same income, if you keep the same phone number.”

If you don’t, you could miss the phone call or the letter telling you it’s time to recertify.

Haley and her colleagues at Urban found that all of this could lead to anywhere between 1.1 million and 2.3 million young adults losing Medicaid over the next couple of years.

“Coverage is projected to fall among young adults in every state that has adopted the ACA [Affordable Care Act] Medicaid expansion.”

How much it’ll fall could vary a lot by state.

“States do have options and can adopt policies that will help to mitigate any potential coverage losses,” said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF.

One option they have, at least next year, that she said could make a big difference is to let people submit a letter saying something like, “I drive 20 hours a week for Uber,” as proof of employment, instead of requiring official pay stubs.

But Nikita Singareddy, CEO of the Medicaid navigation company Fortuna Health, said the No. 1 thing states could do is use data to automatically get people through the renewal process, so they don’t have to submit paperwork every six months.

“No. 2 is, of course, education, but education with navigation partners,” Singareddy said. “So actually people, actually navigators that could guide people through the process.”

It will also be critical that they get the word out in places young people are likely to see it, according to Leo Cuello at Georgetown.

“That means doing outreach campaigns that are not just, you know, in the newspaper, but also showing up on TikTok streams,” he said. “But then, when people need to provide information, you have to have really flexible means of accepting information. So for example, do I have to get a physical copy of my medical record, put it in an envelope, and mail it in?” Or can I take a screenshot of my record and text it in?

The easier states can make it, Cuello said, the more likely young people are to keep their insurance.