New research from the Urban Institute finds that millions of young adults could lose Medicaid coverage when work requirements are implemented next year.
The report, released Monday by the left-leaning think tank, found that as many as 2.3 million people between the ages of 19 and 24 could drop out of Medicaid due to the work requirements, particularly as the need for more frequent check-ins ramps up.
The analysts said young adults are more likely to struggle to keep up with required eligibility determinations because they tend to be transient and may move between states more frequently. Eligible activities they engage in, such as gig work or schooling, are harder for states to capture, per the report.
They estimate that 88% of young adults already engage in an activity that would ensure they are compliant with the work requirements as established in H.R. 1, or the One Big Beautiful Bill Act.
States have some leeway in how they could respond to the work requirements, and any mitigation strategies they deploy will impact how many people ultimately lose coverage, according to the report. Depending on how states roll out their programs, 1.1 million to 2.3 million young adults could fall off the rolls, the study projects.
"The extent of Medicaid coverage drops for this group will depend heavily on state data matching capacity and implementation choices,” said Jennifer Haley, principal research associate at the Urban Institute, in a statement.
In a "high-mitigation scenario" where a state actively works to avoid enrollment losses, enrollment declines could range from 9% to 31%. In a "low-mitigation scenario," losses could range from 22% to 58%.
Strategies states could deploy to help minimize coverage losses among young adults include deploying automatic data matching that can determine eligibility and compliance with work requirements, including any potential exemptions. States can also consider targeted outreach to this group, such as assistance with enrollment and renewals.
Alongside the Medicaid study, Urban Institute released an analysis that found the expiration of the enhanced premium tax credits for Affordable Care Act plans in tandem with changes in H.R. 1 will likely lead to there being fewer than 1 million young adults in subsidized ACA plans.
This trend would be felt in all states, but the bulk of the decline would occur in states that did not expand Medicaid, the researchers said.
"Changes to ACA marketplace subsidies policies and rules could result in many additional young adults losing affordable coverage," Haley said.