Federal Medicaid Eligibility Changes Put Millions at Risk of Losing Coverage

The Congressional Budget Office and others estimate that 5–10 million Americans will lose Medicaid coverage over the next few years; Metcalfe cites about 8 million, with most of the loss stemming from administrative barriers rather than genuine ineligibility. Currently about 20% of Americans (about 75 million people as of March 2026) rely on Medicaid, and national cuts exceed $1 trillion. In January 2026, the Affordable Care Act (ACA) tax subsidies were eliminated, with individual out-of-pocket costs rising 30%–50%; about 92,000 people in Illinois have already dropped out. HR1 (the "Big Beautiful Bill"), effective in October, redefines immigrant eligibility: as of October 1, qualified asylum applicants and victims of domestic violence and human trafficking no longer qualify; about 10,000 people in Illinois will drop out. The biggest impact comes in January: work requirements are introduced for the ACA adult population (80 hours per month of school/work/volunteering), and the redetermination cycle is doubled from once a year to every 6 months, leaving enrollees spending nearly half a year on back-and-forth paperwork. Cook County's CountyCare has so far lost only 11% of its members, but three-quarters of those are due to administrative reasons such as address changes or paperwork not arriving rather than ineligibility; surveys show 55% of enrollees are unaware of the work requirements and 85% are unaware the redetermination frequency has doubled.

• The Congressional Budget Office and others estimate that 5–10 million Americans will lose Medicaid coverage over the next few years; Metcalfe cites about 8 million, with most of the loss stemming from administrative barriers rather than genuine ineligibility. Currently about 20% of Americans (about 75 million people as of March 2026) rely on Medicaid, and national cuts exceed $1 trillion.
• In January 2026, the Affordable Care Act (ACA) tax subsidies were eliminated, with individual out-of-pocket costs rising 30%–50%; about 92,000 people in Illinois have already dropped out. HR1 (the "Big Beautiful Bill"), effective in October, redefines immigrant eligibility: as of October 1, qualified asylum applicants and victims of domestic violence and human trafficking no longer qualify; about 10,000 people in Illinois will drop out.
• The biggest impact comes in January: work requirements are introduced for the ACA adult population (80 hours per month of school/work/volunteering), and the redetermination cycle is doubled from once a year to every 6 months, leaving enrollees spending nearly half a year on back-and-forth paperwork.
• Cook County's CountyCare has so far lost only 11% of its members, but three-quarters of those are due to administrative reasons such as address changes or paperwork not arriving rather than ineligibility; surveys show 55% of enrollees are unaware of the work requirements and 85% are unaware the redetermination frequency has doubled.
• The knock-on effects ripple through the healthcare system and the economy: 2 hospitals in the Chicago area have already closed, with more struggling to make payroll; Illinois estimates 400,000 people will lose Medicaid and become uninsured, and the Commonwealth Fund estimates national GDP will fall by about $154 billion (from hospital closures, unemployment, and people unable to work while sick compounding). Uninsured people do less preventive care, and when hypertension and diabetes go uncontrolled, they end up in the emergency department with strokes and heart attacks.
• In response, Cook County Health has established a cross-sector Medicaid Impact Work Group (including leaders from healthcare, health insurance, state government, business, academia, philanthropy, community, and technology), with three subgroups—"Communication & Education," "Coalition Building," and "Innovation"—and launched an open-source, unbranded website, getmedicaidfacts.com (with direct links to state government, a redetermination event calendar, and FAQs); about 200 faith leaders and multiple state-level agencies have expressed interest in adopting it.