Between 171,000 and 355,000 Michiganders Could Lose Medicaid Coverage Under New Federal Work Requirements

The Numbers Add Up

Between 171,000 and 355,000 Michiganders could lose Medicaid coverage by 2028 under new federal work requirements and more frequent eligibility checks mandated in the Trump administration's One Big Beautiful Bill Act, according to a research report published by the Urban Institute.

The new rules will require many Medicaid enrollees to prove they have worked or completed other approved activities for 80 hours per month. Redeterminations of eligibility will shift from annual to six-month cycles, creating additional administrative hurdles for those trying to maintain coverage.

Michigan Public reported the findings in a story published March 30, 2026, noting the projections depend heavily on how the state responds to the federal mandate.

Who Gets Hit Hardest

The Urban Institute report identified specific groups facing higher risks of losing coverage:

• Self-employed individuals may struggle to verify their income through required documentation
• People with health conditions face challenges in navigating the new process
• Adults between 50 and 64 years old are particularly vulnerable to disenrollment
• Pregnant women and medically frail adults are exempt from work requirements, but exemptions require paperwork that many cannot complete

Matthew Buettgens, a senior fellow with the Urban Institute, told Michigan Public that self-employed workers could have difficulty verifying income. The report noted that those who meet the work requirements may still lose coverage due to difficulty navigating administrative processes for reporting their work activities or exemptions.

The Outreach Timeline

Michigan's Department of Health and Human Services will begin outreach to Healthy Michigan Plan members about the upcoming work requirements by September 30, 2026. The state is preparing to inform enrollees about what qualifies as approved activities and how to document their work hours.

The work requirements officially begin January 1, 2027.

State Mitigation Matters

The report estimates between 4.9 and 10.1 million fewer people across the country will be enrolled in Medicaid expansion coverage in 2028. These numbers depend on mitigation scenarios that each state chooses to implement.

High mitigation approaches use automatic data-matching to see if applicants meet work requirements and eligibility redeterminations. Low mitigation requires more individuals to take direct action and provide documentation of work hours.

Michigan's approach will significantly impact how many Michiganders retain coverage. The state can mitigate impacts by defining exemptions from work requirements more flexibly and limiting the amount of paperwork applicants need to submit.

Why This Matters

The Urban Institute report warns that losing Medicaid coverage can lead to worse health outcomes, financial burdens, barriers to employment, and delays or inability to receive essential care.

Matthew Buettgens emphasized that the benefits of having coverage are broad across health and financial security. Interruptions in coverage could disrupt both areas of life, creating cascading effects for families already struggling with the economic pressures of the current year.

The Bigger Picture

These federal requirements build on a series of Medicaid policy changes under the Trump administration. The state faces additional pressures as the federal government passes tab on programs like SNAP and Medicaid, while the state simultaneously faces a more than $1 billion decline in revenue this year.

The Michigan Budget Director has noted that the governor's proposal includes investments to help maintain access to healthcare and food assistance, but the new federal rules add another layer of complexity to an already challenging budget environment.

Michigan Public's analysis of the Urban Institute report provides one of the clearest pictures of what lies ahead for Medicaid enrollees in the state over the next two years. The findings underscore that policy choices at the state level will determine how many Michiganders retain coverage under the new federal requirements.