Trust.Care Helps Workers with Medicaid and Their Struggles to Maintain Coverage

Working Medicaid beneficiaries are expected to face significant challenges with verification and recertification under the impending One Big Beautiful Bill Act (OBBBA), even if they are employed. The new law introduces additional complexity, frequent proof of eligibility, and risks of losing coverage for millions. Even currently working Medicaid beneficiaries could be disenrolled—despite being employed—if they run into paperwork snafus, variable work hours, missed communications, technology problems, or other verification hurdles under OBBBA’s stricter rules. Previous state experience shows the result is often large numbers of eligible people dropping off Medicaid for procedural reasons, not because of actual ineligibility[3][8][5]. Here are the primary reasons and real-world examples of what they are likely to encounter:

Key Reasons and Examples of Problems

 1. Frequent and Burdensome Verification

• New Frequency: Under OBBBA, Medicaid expansion enrollees must now re-verify eligibility at least every six months (instead of annually). States can make verification even more frequent, greatly increasing administrative burden[1][2][3][4].

• Work Requirement Proof: Working-age adults (ages 19–64) must prove they complete at least 80 hours per month of work, volunteering, or approved education activities. Even if they’re already working, proof is required at application and recurring eligibility checks[2][1][3][5][6].

• Example: A part-time worker with variable hours, or someone with multiple gig jobs, may struggle to prove a consistent 80 hours each month, especially if their hours fluctuate seasonally or due to unpredictable shift scheduling.

 2. Documentation and “Look-Back” Periods

• Retroactive Checks: States must “look back” at up to three months before application to confirm compliance with work requirements. At recertification (at least every six months), states can also check for compliance over multiple recent months[2][5].

• Example: Someone who lost a job in April, got a new job in June, and applies in July would be denied in states using the full three-month look-back if they missed required hours in two of those three months—even if they’re currently employed[2].

 3. Technology and Communication Barriers

• Outdated Systems: Many states’ eligibility systems are old or poorly integrated with other data (like SNAP, TANF, or employer records), increasing the chance that work is not auto-verified and the individual is forced to provide manual proof[1][3].

• Missed Notices: Beneficiaries who move, are unhoused, or have language barriers may never receive verification requests or may struggle to complete online or mailed documentation, risking coverage loss[1][7].

• Example: A Medicaid worker with limited internet or phone access may miss a mailing or struggle with an online portal, triggering termination notices.

 4. Procedural Disenrollment and Administrative Churn

• Red Tape: Many will lose Medicaid not because they fail to meet work/activity rules but because complex or confusing paperwork, missed deadlines, or reporting system difficulties lead to disenrollment[3][8][5].

• Reapplication Problem: After a noncompliance notice, workers have 30 days to prove they qualify. If they do not, they must start over, triggering new documentation hurdles and possible gaps in care[2][5][9].

• Example: During a previous Medicaid work requirement in Arkansas, over 18,000 people lost coverage primarily due to administrative process barriers—not because they were unemployed[3][8].

 5. Increased Risk for Vulnerable and Low-Wage Workers

• Gig, Part-Time, and Seasonally Employed: Many working Medicaid beneficiaries hold jobs with fluctuating hours, lack official payroll records, or switch jobs frequently, making it much harder to consistently document required hours[8][3].

• Example: A self-employed cleaner, rideshare driver, or agricultural worker may have trouble getting official documentation to prove work, or their hours may dip below the threshold in some months.

6. Loss of Other Health Coverage Options

• ACA Marketplace Exclusion: Those who lose Medicaid for not meeting work requirements are also barred from getting subsidized ACA Marketplace coverage, increasing risk of uninsurance[2][5].

A Proven Pathway to Boost Coverage Retention

Trust.Care: Purpose-Built Platform for Medi-Cal Enrollment, Retention & Compliance. Value Proposition:

• 50%+ of Medicaid disenrollments are procedural—not eligibility-based.

• New work requirement mandates (e.g., BBB) place burdens on vulnerable members.

• Every 1,000 retained members = ~$6M/year in plan capitation + $500+/member in provider reimbursement.

• Trust unifies enrollment, documentation, navigation, and compliance in one trusted platform.

What Makes Trust Different

• Community-First Engagement: Mobilizes CHWs, ECM providers, and FQHCs to meet members where they are.

• Integrated Community Network Coordination: Enables seamless collaboration across clinics, CBOs, and faith organizations, centralizing documentation and navigation

• Multilingual, Omni-Channel Access: SMS, phone, and in-person outreach in 112+ languages.

• Full-Spectrum Member Management: Enrollment, redetermination, exemption support, care coordination.

• Agentic Workflows + Closed-Loop Referrals: Automated, trackable support for post-enrollment care and compliance.

• Automated, Real-Time Workflows: Reduces administrative burden via document upload, instant dashboards, and interoperability with health and social data systems.

• EMR + Social Care Integration: Real-time ingestion of MIF, OTF, and RTF; bi-directional referrals with provider systems.

• Fast Launch, Low Lift: Go live in <4 weeks with prebuilt templates and dashboards.

• Performance-Based Pricing: Value-based pricing and aligned provider incentives.

Financial & Operational ROI

Benefit:

• Member Retention

• Provider Reimbursements

• Performance-Based Priing

• Speed to Lauch

Value:

• ~$6M/year per 1,000 retained members

• $500+/member/year + incentive bonuses

• Pay only for verified enrollment outcomes

• Go live in under 4 weeks

Trusted by the Community

• Streamlined Claims: Centralized engagement and claims reporting across MCPs.

• Effective Navigation: Real-time dashboards guide members through eligibility processes.

• Proven Outcomes: Real case studies show coverage retention and care connection impact.

Enterprise-Grade Security & Interoperability

• HIPAA-Compliant Architecture with bank-grade encryption and AWS validation.

• Seamless integration with EMRs, social care platforms, and provider workflows.

 Check us out: https://www.trust.care/

 Sources

[1] What the OBBBA Means for Medicare, Medicaid, and the Affordable ... https://www.itcu.org/resources/news/blog/what-the-obbba-means-for-medicare--medicaid--and-the-affordable-care-act

[2] A Closer Look at the Work Requirement Provisions in the 2025 ... - KFF https://www.kff.org/medicaid/issue-brief/a-closer-look-at-the-work-requirement-provisions-in-the-2025-federal-budget-reconciliation-law/

[3] Federal Medicaid Work Requirements: What States Should Know https://www.aurrerahealth.com/blog/federal-medicaid-work-requirements-what-states-should-know

[4] OBBBA's Medicaid Cuts May Endanger Hospital 340B Eligibility https://compliancecosmos.org/obbbas-medicaid-cuts-may-endanger-hospital-340b-eligibility

[5] A Closer Look at the Medicaid Work Requirement Provisions ... - KFF https://www.kff.org/medicaid/issue-brief/a-closer-look-at-the-medicaid-work-requirement-provisions-in-the-big-beautiful-bill/

[6] One Big Beautiful Bill Act: Understanding the healthcare impacts https://www.advisory.com/topics/strategic-and-business-planning/obbba-healthcare-impacts

[7] Post OBBBA in Medicaid: Navigating in a New Landscape https://medicaidplans.org/event/post-obbba-in-medicaid-navigating-in-a-new-landscape/

[8] Medicaid Work Requirements Don't Work — They Harm People with ... https://www.aclu.org/news/disability-rights/medicaid-work-requirements-dont-work-they-harm-people-with-disabilities

[9] The Truth About the One Big Beautiful Bill Act's Cuts to Medicaid and ... https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/

[10] The One Big Beautiful Bill Act (OBBBA) & Credit Reporting Rule https://unduemedicaldebt.org/the-one-big-beautiful-bill-act-obbba-credit-reporting-rule-what-you-need-to-know/

[11] The One Big Beautiful Bill Act Explained: A Detailed Review of Key ... https://www.kslaw.com/news-and-insights/the-one-big-beautiful-bill-act-explained-a-detailed-review-of-key-changes-for-the-healthcare-industry

[12] The One Big Beautiful Bill Act (OBBBA) - PwC https://www.pwc.com/us/en/industries/health-industries/library/impact-of-obbba-on-us-health-system.html

[13] What Health Care Provisions of the One Big Beautiful Bill Act Mean ... https://nashp.org/what-health-care-provisions-of-the-one-big-beautiful-bill-act-mean-for-states/

[14] Redefining Access: What OBBBA (HR 1) Means for Dual Eligibles https://atiadvisory.com/resources/redefining-access-what-obbba-means-for-dual-eligibles/

[15] OBBBA Medicaid Cuts: State-by-State Impact Analysis - FinThrive https://finthrive.com/blog/obbba-medicaid-cuts-state-by-state-impact-analysis?hsLang=en

[16] What OBBBA Means for Medicaid, HCBS, and Long-Term Services ... https://atiadvisory.com/resources/what-obbba-means-for-medicaid-hcbs-ltss/

[17] Millions of CHC Patients Could Lose Medicaid Under Work ... https://www.commonwealthfund.org/blog/2025/community-health-center-patients-medicaid-coverage-work-requirements

[18] OBBBA Reshapes Medicaid—Eligibility, Financing & Coverage Cuts https://natlawreview.com/article/one-big-beautiful-bill-slashed-budgets-will-disrupt-medicaid-program

[19] Fraud and Abuse Against Medicaid: Rhetoric and Reality in the One ... https://ccf.georgetown.edu/2025/06/06/fraud-and-abuse-against-medicaid-rhetoric-and-reality-in-the-one-big-beautiful-bill-act/

[20] From Bacon's Desk: The Truth About Medicaid Work Requirements https://bacon.house.gov/news/documentsingle.aspx?DocumentID=2732