CBO Reaffirms Forecast of Major Medicaid Coverage Reductions
If you currently rely on Medicaid or are uninsured and wondering whether you may still be able to enroll, the Congressional Budget Office's reaffirmed forecast of dramatic coverage reductions in 2026 and beyond is directly relevant to your healthcare access. The CBO—Congress's nonpartisan fiscal scorekeeper—has projected that proposed federal legislative changes could result in millions of Americans losing Medicaid eligibility or coverage, representing one of the most significant potential shifts in public health insurance in decades. Understanding what's driving these projections, and what steps may help protect your access to care, is critical right now.
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What the CBO Forecast Actually Says
The Century Foundation's analysis of the CBO's updated projections highlights that proposed changes to Medicaid financing and eligibility rules—including potential work requirements, more frequent eligibility redeterminations, and reductions in federal matching funds—could reduce Medicaid enrollment significantly starting in 2026. The CBO's estimates are not predictions of what will definitely happen; they are scored projections based on legislation under consideration. However, they carry significant weight because they reflect the agency's best nonpartisan analysis of likely real-world outcomes.
Key mechanisms that could drive coverage losses, based on policy proposals under review, include:
- Work or community engagement requirements: Enrollees in certain eligibility categories may be required to document employment, job training, or volunteer hours to maintain coverage.
- More frequent eligibility redeterminations: States may be required to verify eligibility more often, increasing the risk of administrative disenrollment—losing coverage not because you're ineligible, but because paperwork wasn't completed in time.
- Changes to federal matching rates (FMAP): Reductions in how much the federal government reimburses states for Medicaid costs could lead states to tighten eligibility or reduce covered services.
None of these changes are final as of this writing. But the CBO's reaffirmation of its earlier forecast signals that the risk is real and worth preparing for.
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Who Is Most at Risk of Losing Coverage
Medicaid Expansion Enrollees Adults enrolled through the ACA Medicaid expansion—generally those with household incomes at or below 138% of the Federal Poverty Level (FPL)—represent a large share of the population the CBO projects could be affected. Expansion coverage has been a primary target of proposed federal changes.
People Subject to Work Requirements If work requirements are implemented, adults between ages 19 and 64 who are not already exempt (due to disability, caregiving responsibilities, or other factors) may need to document qualifying activity. Historically, work requirement pilots have led to significant coverage losses primarily due to reporting burdens, not actual ineligibility.
Enrollees Who Miss Renewal Notices Administrative disenrollment is a persistent problem. During the COVID-19 continuous enrollment period, millions were found ineligible or lost coverage during the 2023–2024 unwinding process—not always because their circumstances changed, but because renewal paperwork was missed. The same risk applies if redetermination frequency increases.
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What You Should Do Right Now
Step 1: Confirm Your Current Medicaid Enrollment Status Contact your state Medicaid agency directly or log into your state's Medicaid portal to verify that your coverage is active and that your contact information—mailing address, phone number, email—is current. Renewal notices are sent to the address on file. An outdated address is one of the most common reasons people lose coverage they're still eligible for.
Step 2: Respond to Every Renewal Notice Immediately If you receive a renewal packet or a request for information from your state Medicaid agency, treat it as urgent. Most states give enrollees 30 to 90 days to respond, but delays increase the risk of a gap in coverage. Required documents typically include: - Proof of identity (government-issued ID) - Proof of residency (utility bill, lease agreement) - Proof of income (pay stubs, tax returns, employer letter) - Social Security numbers for all household members applying
Step 3: Understand Your ACA Marketplace Options If you lose Medicaid coverage, you may be eligible for a Special Enrollment Period (SEP) on the ACA Health Insurance Marketplace. Loss of Medicaid qualifies as a qualifying life event, giving you 60 days from the date of coverage loss to enroll in a Marketplace plan. Households with incomes between 100% and 400% FPL—and in some cases above 400% FPL under current law—may be eligible for premium tax credits that reduce monthly costs. Households below 150% FPL may qualify for plans with $0 or very low premiums.
To explore Marketplace options, visit HealthCare.gov or your state's exchange if your state operates its own.
Step 4: Locate a Federally Qualified Health Center (FQHC) Federally Qualified Health Centers—also called Community Health Centers—are federally funded clinics required to serve patients regardless of their ability to pay. They use a sliding-fee scale based on income and household size. Even if your Medicaid coverage is disrupted, an FQHC may provide primary care, dental, mental health, and prescription services at reduced or no cost. Find the nearest FQHC through the Health Resources and Services Administration (HRSA) Find a Health Center tool at findahealthcenter.hrsa.gov.
Step 5: Explore Prescription Assistance Programs If drug coverage is disrupted, several programs may help: - NeedyMeds (needymeds.org): A nonprofit database of patient assistance programs by drug name and manufacturer. - RxAssist (rxassist.org): Tracks pharmaceutical manufacturer assistance programs. - Extra Help / Low Income Subsidy (LIS): For Medicare Part D enrollees, this federal program helps with prescription drug costs for people with limited income and resources. Eligibility is generally at or below 150% FPL.
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CHIP: Coverage for Children Remains a Priority The Children's Health Insurance Program (CHIP) provides coverage for children in households with incomes generally between 138% and 300% FPL (thresholds vary by state). CHIP is a separate program from Medicaid, though administered jointly. Families concerned about children's coverage should contact their state CHIP agency to verify enrollment and understand how proposed changes may or may not affect children's eligibility in their state.
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A Note on State Variation Medicaid is a federal-state partnership, and the impact of any federal policy changes will vary significantly by state. States that have expanded Medicaid under the ACA and states that have not will face different fiscal and policy pressures. Some states may choose to maintain broader eligibility using state-only funds; others may implement changes quickly. Monitoring your state Medicaid agency's announcements is essential.
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People Also Ask
If I lose Medicaid, how long do I have to enroll in an ACA Marketplace plan? Loss of Medicaid coverage qualifies as a Special Enrollment Period trigger. You generally have 60 days from the date your Medicaid coverage ends to enroll in a Marketplace plan. Acting quickly matters—missing this window means waiting until the next Open Enrollment Period, typically November 1 through January 15.
What income level qualifies for Medicaid in 2026? In states that have expanded Medicaid under the ACA, adults with household incomes at or below 138% of the Federal Poverty Level may be eligible. Non-expansion states have narrower eligibility rules, often limited to specific categories such as pregnant women, children, or people with disabilities. Exact dollar thresholds change annually with FPL updates.
What are work requirements in Medicaid, and are they in effect now? Work requirements—also called community engagement requirements—would require certain adult Medicaid enrollees to document employment, job training, or volunteer hours to maintain eligibility. As of early 2026, no nationwide work requirement is in effect, but legislation proposing them is under active congressional consideration. Check your state Medicaid agency for the latest status.
Can I get healthcare if I lose Medicaid and can't afford Marketplace premiums? Federally Qualified Health Centers (FQHCs) provide care on a sliding-fee scale regardless of insurance status. Additionally, some states have state-funded programs for low-income uninsured residents. Emergency Medicaid may cover acute care for people who meet income criteria but are otherwise ineligible. Contact your local FQHC or 211 helpline for local resources.
Does losing Medicaid affect my children's CHIP coverage? Not automatically. CHIP is a separate program with its own eligibility rules, and a parent losing Medicaid does not directly terminate a child's CHIP enrollment. However, families should verify children's CHIP status independently and respond to any renewal notices for children's coverage separately from adult Medicaid renewals.
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Last reviewed: April 2026